From the Guidelines
Urinary tract infections (UTIs) should be treated with short-course antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1. The treatment of UTIs depends on the type and severity of the infection. For uncomplicated UTIs, the following antibiotics are recommended:
- Nitrofurantoin (Macrobid) 100mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days
- Fosfomycin (Monurol) 3g single dose These antibiotics are effective against the most common cause of UTIs, Escherichia coli, and have a low risk of resistance 1. While waiting for antibiotics to work, patients should:
- Drink plenty of water to help flush out the bacteria
- Urinate frequently to help clear the infection
- Take phenazopyridine (AZO) 100-200mg three times daily for 2 days to relieve painful urination
- Use ibuprofen or acetaminophen to manage pain and fever It is essential to complete the full antibiotic course, even if symptoms improve quickly, to ensure that the infection is fully cleared 1. Prevention strategies include:
- Proper wiping technique
- Urinating after sexual activity
- Staying well-hydrated
- Avoiding spermicidal-containing contraceptives
- Using topical vaginal estrogens in postmenopausal women with risk factors for recurrent UTIs 1. If symptoms worsen or include fever above 101°F, back pain, nausea, or vomiting, medical attention should be sought immediately, as these may indicate a kidney infection 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination
The treatment for Urinary Tract Infection (UTI) is with a single effective antibacterial agent, such as trimethoprim-sulfamethoxazole or ciprofloxacin, for susceptible strains of organisms including Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris 2 3.
- Key points:
- Use a single effective antibacterial agent for initial episodes of uncomplicated UTIs
- Select therapy based on culture and susceptibility information, or local epidemiology and susceptibility patterns if such data is not available
- Trimethoprim-sulfamethoxazole and ciprofloxacin are options for treatment of UTIs due to susceptible organisms
From the Research
Treatment Options for Urinary Tract Infections (UTIs)
The treatment for UTIs depends on the type of infection and the causative organism. According to 4, the recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is:
- A 5-day course of nitrofurantoin
- A 3-g single dose of fosfomycin tromethamine
- A 5-day course of pivmecillinam
Second-Line Treatment Options
Second-line options include:
- Oral cephalosporins such as cephalexin or cefixime
- Fluoroquinolones
- β-lactams, such as amoxicillin-clavulanate 4
Treatment for Specific Types of UTIs
For UTIs due to:
- AmpC- β-lactamase-producing Enterobacteriales: nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems are recommended 4
- ESBLs-E coli: nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin are recommended 4
- ESBLs-Klebsiella pneumoniae: pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin are recommended 4
- Carbapenem-resistant Enterobacteriales (CRE): ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam, and cefiderocol are recommended 4
- Multidrug resistant (MDR)-Pseudomonas spp.: fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides, aztreonam, and cefiderocol are recommended 4
General Principles of Treatment
The choice of antibiotic should be based on the pharmacokinetic characteristics of the molecule to optimize clinical benefit and minimize the risk of antibacterial resistance 5. Empirical antibiotic treatment should be based on the patient's clinical data and local sensitivity data 6. The results of susceptibility testing should be awaited whenever possible to guide treatment 7.