From the Guidelines
Antibiotics are the primary treatment for urinary tract infections (UTIs), with first-line options including nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose, as recommended by the most recent guidelines 1. The choice of antibiotic depends on patient factors, local resistance patterns, and infection severity.
- Uncomplicated UTIs can be treated with short courses (3-5 days) of antibiotics, while complicated infections may require 7-14 days of treatment.
- Fluoroquinolones like ciprofloxacin 250-500mg twice daily for 3-7 days can be used for more complicated infections, but are typically reserved due to resistance concerns.
- Phenazopyridine (Pyridium) 100-200mg three times daily can provide symptom relief, but does not treat the infection itself.
- Drinking plenty of water helps flush bacteria from the urinary tract, and cranberry products may help prevent recurrent UTIs by preventing bacterial adhesion to the bladder wall, though they do not treat active infections. The most recent guidelines from the American College of Physicians 1 emphasize the importance of using short-course antibiotics to minimize the risk of antibiotic resistance and adverse effects.
- The guidelines recommend using nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin as first-line treatments for uncomplicated UTIs.
- For complicated UTIs, the guidelines recommend using fluoroquinolones or trimethoprim-sulfamethoxazole, depending on the severity of the infection and local resistance patterns. Overall, the treatment of UTIs should be guided by the most recent clinical guidelines and should take into account patient factors, local resistance patterns, and infection severity, as recommended by the highest quality study 1.
From the FDA Drug Label
- 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis
- 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa
- 11 Acute Pyelonephritis: 5 or 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia
- 12 Uncomplicated Urinary Tract Infections Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus
The medication for Urinary Tract Infection (UTI) is levofloxacin.
- Complicated UTI: due to Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, or Pseudomonas aeruginosa
- Uncomplicated UTI: due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 2
From the Research
Medications for Urinary Tract Infection (UTI)
The following medications are used to treat UTIs:
- Nitrofurantoin: a 5-day course for uncomplicated UTIs 3, 4, 5, 6
- Fosfomycin: a single dose for uncomplicated UTIs 3, 4, 6
- Trimethoprim: a 3-day course for uncomplicated UTIs 3
- Trimethoprim/sulfamethoxazole: a 3-day course for uncomplicated UTIs 3, 4, 6
- Pivmecillinam: a 5-day course for uncomplicated UTIs 4
- Cephalexin: a second-line option for UTIs 4
- Cefixime: a second-line option for UTIs 4
- Fluoroquinolones: a second-line option for UTIs, but with high rates of resistance 4
- Amoxicillin-clavulanate: a second-line option for UTIs 4, 7
- Cefpodoxime: a first-line option for UTIs in some cases 7
- Ceftriaxone: a first-line option for UTIs in some cases 7
Treatment Duration
The treatment duration for UTIs varies depending on the medication and the individual case:
- Nitrofurantoin: 5 days for uncomplicated UTIs 3, 5
- Fosfomycin: single dose for uncomplicated UTIs 3, 4
- Trimethoprim: 3 days for uncomplicated UTIs 3
- Trimethoprim/sulfamethoxazole: 3 days for uncomplicated UTIs 3
- Pivmecillinam: 5 days for uncomplicated UTIs 4
- Cefpodoxime: duration not specified 7
- Ceftriaxone: duration not specified 7
Special Considerations
Certain individuals may require special consideration when treating UTIs:
- Pregnant women: not specified in the provided studies
- Men: first-line antibiotics include trimethoprim, trimethoprim/sulfamethoxazole, and nitrofurantoin for 7 days 3
- Nonfrail women and men 65 years and older: first-line antibiotics and treatment durations do not differ from those recommended for younger adults 3
- Patients with recurrent infections: increased fluids, intake of cranberry products, and methenamine hippurate can prevent recurrent infections 3
- Patients with antibiotic-resistant UTIs: alternative treatment options include oral cephalosporins, fluoroquinolones, and β-lactams 4