What are the medications for Urinary Tract Infection (UTI)?

From the Guidelines

For a urinary tract infection (UTI), the most effective first-line treatment is a course of antibiotics, with nitrofurantoin (Macrobid) 100mg twice daily for 5 days or trimethoprim-sulfamethoxazole (Bactrim) DS tablet twice daily for 3 days being the preferred options, as recommended by the American College of Physicians in 2021 1.

Treatment Options

The choice of antibiotic depends on the severity and complexity of the UTI, as well as the patient's medical history and potential allergies.

• Nitrofurantoin and trimethoprim-sulfamethoxazole are generally considered first-line treatments for uncomplicated UTIs in women, due to their efficacy and low resistance rates 1.
• Fosfomycin is also an option for uncomplicated UTIs, although it may have inferior efficacy compared to other treatments 1.
• Fluoroquinolones, such as ciprofloxacin, are typically reserved for more serious or complicated UTIs, due to concerns about resistance and adverse effects 1.

Treatment Duration

The duration of treatment also depends on the severity and complexity of the UTI, as well as the patient's response to treatment.

• Uncomplicated UTIs in women can typically be treated with a 3-5 day course of antibiotics 1.
• Men and those with complicated UTIs may require longer treatment courses, often 7-14 days 1.

Additional Measures

In addition to antibiotics, there are several other measures that can help alleviate symptoms and support recovery from a UTI.

• Drinking plenty of water can help flush bacteria from the urinary tract 1.
• Over-the-counter pain relievers, such as ibuprofen, can help reduce discomfort and pain 1.
• Phenazopyridine (AZO) can be taken for pain relief, although it may turn urine orange 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 Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients:

The medications for Urinary Tract Infection (UTI) are:

• Trimethoprim-sulfamethoxazole (PO): The usual adult dosage is 1 sulfamethoxazole and trimethoprim DS tablet every 12 hours for 10 to 14 days 2
• Ciprofloxacin (PO): Used for complicated urinary tract infections and pyelonephritis in pediatric patients 1 to 17 years of age 3

From the Research

Medications for Urinary Tract Infection (UTI)

The following medications are used to treat UTIs:

• Nitrofurantoin: a 5-day course for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 4, 5, 6
• Fosfomycin tromethamine: a 3-g single dose for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 4, 7, 8
• Pivmecillinam: a 5-day course for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 4, 7
• Trimethoprim-sulfamethoxazole: a 3-day course for uncomplicated UTIs, but its use is limited due to high rates of resistance 5, 8
• Fluoroquinolones: for uncomplicated pyelonephritis, but their use is also limited due to increasing resistance rates 7, 8
• Oral cephalosporins (e.g., cephalexin, cefixime): second-line options for UTIs 4
• β-lactams (e.g., amoxicillin-clavulanate): second-line options for UTIs 4, 8
• Carbapenems (e.g., meropenem/vaborbactam, imipenem/cilastatin-relebactam): for UTIs caused by carbapenem-resistant Enterobacteriales or multidrug-resistant Pseudomonas spp. 4
• Aminoglycosides (e.g., plazomicin): for UTIs caused by carbapenem-resistant Enterobacteriales or multidrug-resistant Pseudomonas spp. 4
• Ceftazidime-avibactam: for UTIs caused by carbapenem-resistant Enterobacteriales or multidrug-resistant Pseudomonas spp. 4
• Cefiderocol: for UTIs caused by carbapenem-resistant Enterobacteriales or multidrug-resistant Pseudomonas spp. 4

Treatment Options for Specific Types of UTIs

• UTIs due to AmpC-β-lactamase-producing Enterobacteriales: nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems 4
• UTIs due to ESBLs-E coli: nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 4
• UTIs due to ESBLs-Klebsiella pneumoniae: pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 4
• UTIs caused by multidrug-resistant Pseudomonas spp.: fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides, and cefiderocol 4