From the Guidelines
For uncomplicated urinary tract infections (UTIs) in adults, first-line treatment typically involves a short-course of antibiotics, such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1.
Treatment Options
- Nitrofurantoin: 100 mg twice daily for 5 days
- Trimethoprim-sulfamethoxazole (TMP-SMX): 160/800 mg twice daily for 3 days
- Fosfomycin: 3 g as a single dose
Considerations
- Patients with uncomplicated pyelonephritis should be treated with either fluoroquinolones (5 to 7 days) or TMP-SMX (14 days) based on antibiotic susceptibility 1.
- Complicated UTIs, such as those in men, pregnant women, or patients with anatomical abnormalities, require longer treatment courses (7-14 days) and possibly broader-spectrum antibiotics.
- Patients should complete the entire antibiotic course even if symptoms improve quickly to prevent recurrence and antibiotic resistance.
- If symptoms worsen or don't improve within 48-72 hours, patients should seek medical attention as culture and sensitivity testing may be needed to guide appropriate antibiotic selection.
Prevention Strategies
- Adequate hydration
- Urinating after sexual intercourse
- Wiping from front to back after using the toilet The American College of Physicians recommends short-course antibiotics for uncomplicated UTIs, which is supported by the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.
From the FDA Drug Label
Urinary Tract Infections and Shigellosis in Adults and Pediatric Patients, and Acute Otitis Media in Children Adults: The usual adult dosage in the treatment of urinary tract infections is 1 sulfamethoxazole and trimethoprim DS tablet every 12 hours for 10 to 14 days
The treatment for Urinary Tract Infection (UTI) in adults is 1 sulfamethoxazole and trimethoprim DS tablet every 12 hours for 10 to 14 days 2.
- The recommended dosage is for the treatment of urinary tract infections due to susceptible strains of certain organisms, including Escherichia coli, Klebsiella species, and Proteus mirabilis 2.
- It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination 2.
From the Research
Treatment Options for Urinary Tract Infections (UTIs) in Adults
- The primary treatment for UTIs in adults involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the presence of any complicating factors 3, 4, 5, 6, 7.
- First-line antibiotics for uncomplicated UTIs include nitrofurantoin, fosfomycin, trimethoprim, and trimethoprim/sulfamethoxazole 4, 6, 7.
- Nitrofurantoin has been shown to be effective in treating acute uncomplicated UTIs, with a microbial eradication rate of 92.3% at 12 to 16 days after baseline 3.
- The duration of antibiotic treatment varies depending on the specific antibiotic and the severity of the infection, ranging from a single dose to 7 days 4, 6.
Considerations for Specific Patient Populations
- In men with lower UTI symptoms, antibiotics should always be prescribed, with urine culture and susceptibility results guiding the antibiotic choice 4.
- In nonfrail women and men 65 years and older with no relevant comorbidities, urine culture with susceptibility testing is recommended to adjust the antibiotic choice after initial empiric treatment 4.
- In pregnant women, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim/sulfamethoxazole can be appropriate treatments for UTIs 7.