What is the treatment for ureteritis in females?

From the Guidelines

Treatment for ureteritis in females should be guided by the most recent and highest quality evidence, which recommends antibiotics such as azithromycin or doxycycline as first-line therapy. According to the European Association of Urology guidelines on urological infections, published in 2024 1, the suggested antimicrobial therapy regimens for urethritis include azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice a day for 7 days.

Key Considerations

• The choice of antibiotic should be based on the suspected or confirmed pathogen, as well as local resistance patterns.
• Patients with severe symptoms or suspected pyelonephritis may require hospitalization with IV antibiotics.
• Pain management with NSAIDs like ibuprofen or acetaminophen can help control discomfort.
• Increasing fluid intake to 2-3 liters daily can help flush bacteria from the urinary tract.
• Follow-up urine cultures are important to confirm the infection has cleared.

Additional Interventions

• If ureteritis is related to kidney stones, additional interventions like ureteroscopy may be required.
• Patients should be instructed to abstain from sexual intercourse until 7 days after therapy is initiated, as recommended by the Centers for Disease Control and Prevention 1.
• Partner referral and evaluation are also important, especially if the ureteritis is suspected to be caused by a sexually transmitted infection.

Prevention of Recurrent Infections

• The use of vaginal estrogen with or without lactobacillus-containing probiotics in postmenopausal women, as well as low-dose post-coital antibiotics for recurrent UTI associated with sexual activity in premenopausal women, may be considered as preventive measures, as suggested by a rapid review with practice recommendations published in 2018 1.

From the FDA Drug Label

INDICATIONS AND USAGE Ciprofloxacin Tablets USP, 250 mg, 500 mg and 750 mg is indicated for the treatment of infections caused by susceptible strains of the designated microorganisms in the conditions and patient populations listed below. Adult Patients: Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis Acute Uncomplicated Cystitis in females caused by Escherichia coli or Staphylococcus saprophyticus.

The treatment for ureteritis in females may involve the use of antibiotics such as ciprofloxacin 2, which is indicated for the treatment of urinary tract infections, including those caused by susceptible strains of bacteria. However, ureteritis is not explicitly mentioned in the provided drug labels.

• The provided drug labels do mention the treatment of urinary tract infections and acute uncomplicated cystitis in females.
• Ciprofloxacin 2 and trimethoprim-sulfamethoxazole 3 are both used to treat urinary tract infections, but the labels do not specifically address ureteritis.

Given the information available, it is not possible to determine a specific treatment for ureteritis in females based on the provided drug labels.

From the Research

Ureteritis Treatment in Females

• Ureteritis is an infection of the ureter, and its treatment depends on the underlying cause and severity of the infection 4.
• Most cases of ureteritis are infective, and may be due to any of the organisms normally found in urinary tract infections, particularly Escherichia Coli, staphylococci, streptococci, enterococci, proteus, and pyocyaneus 4.
• The first step in treatment must be toward the elucidation and cure of any underlying lesion, such as calculi, cystitis, pyelitis, and so on 4.
• Treatment options for urinary tract infections (UTIs) include:
  • Nitrofurantoin, a 5-day course, as a recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5.
  • Fosfomycin tromethamine, a 3-g single dose, as a recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5.
  • Pivmecillinam, a 5-day course, as a recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 5.
  • Oral cephalosporins, such as cephalexin or cefixime, as second-line options 5.
  • Fluoroquinolones and β-lactams, such as amoxicillin-clavulanate, as second-line options 5.
• For ureteritis specifically, treatment may involve:
  • Antibiotics to treat the underlying infection 4.
  • Dilation or excision of the stenosed portion of the ureter in chronic cases with stricture formation 4.
  • Ureteral stenting to preserve renal function 4.
• It is essential to use the new antimicrobials wisely for treatment of UTIs caused by multidrug-resistant (MDR) organisms to avoid resistance development 5.