What medications can be prescribed for Urinary Tract Infection (UTI) with symptoms of bladder pressure?

From the Guidelines

For urinary tract infections (UTIs) with bladder pressure symptoms, the most effective treatment options include nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS tablet twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose, as recommended by the American College of Physicians in 2021 1. These first-line treatments are preferred due to their efficacy and minimal resistance rates.

• Nitrofurantoin is a suitable choice for therapy due to its minimal resistance and propensity for collateral damage, with efficacy comparable to trimethoprim-sulfamethoxazole 2.
• Trimethoprim-sulfamethoxazole is also an appropriate choice for therapy, given its efficacy as assessed in numerous clinical trials, if local resistance rates of uropathogens causing acute uncomplicated cystitis do not exceed 20% 2.
• Fosfomycin is an appropriate choice for therapy where it is available due to minimal resistance and propensity for collateral damage, but it appears to have inferior efficacy compared with standard short-course regimens 2. In addition to antibiotics, patients should be advised to complete the full antibiotic course even if symptoms improve, drink plenty of water to help flush bacteria, and urinate frequently.
• Fluoroquinolones like ciprofloxacin may be used for more severe infections, though these are typically reserved for complicated cases due to resistance concerns 1. It is essential to note that the choice of antibiotic should be based on the patient's specific situation, including the severity of symptoms, local resistance rates, and potential allergies or interactions.
• Phenazopyridine (Pyridium) 100-200mg three times daily for 2 days can help relieve bladder pain and pressure while the antibiotics take effect, but it should not be used as a substitute for antibiotic therapy. Overall, the goal of treatment is to alleviate symptoms, prevent complications, and improve quality of life, while also considering the potential risks and benefits of each treatment option 1.

From the FDA Drug Label

14. 7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen

To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I. V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I. V. or 500 mg orally twice daily for 10 days (563 patients).

Medications for UTI with symptoms of bladder pressure:

• Levofloxacin: can be prescribed for complicated urinary tract infections (cUTI) and acute pyelonephritis (AP)
• Ciprofloxacin: can be prescribed for cUTI and AP

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From the Research

Medications for Urinary Tract Infection (UTI) with Bladder Pressure Symptoms

The following medications can be prescribed for UTI with symptoms of bladder pressure:

• 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 7, 4, 8
• Pivmecillinam: a 5-day course for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 7, 4
• Trimethoprim-sulfamethoxazole: a 3-day course for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females, although its use is limited due to high rates of resistance 4, 5
• Fluoroquinolones: a high-dosage course for uncomplicated pyelonephritis, although their use is limited due to high rates of resistance 7, 4

Second-Line Options

Second-line options for UTI treatment include:

• Oral cephalosporins such as cephalexin or cefixime 4
• β-lactams, such as amoxicillin-clavulanate 4
• Fluoroquinolones, although their use is limited due to high rates of resistance 4

Treatment for Specific Types of UTIs

Treatment options for UTIs due to specific types of bacteria include:

• ESBL-E coli: nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 4
• ESBL-Klebsiella pneumoniae: pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin 4
• Carbapenem-resistant Enterobacteriales (CRE): ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam, and cefiderocol 4
• Multidrug-resistant (MDR)-Pseudomonas spp.: fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, and fosfomycin 4