From the Guidelines
For treating uncomplicated urinary tract infections (UTIs) in outpatients, first-line therapy is typically nitrofurantoin (Macrobid) 100mg twice daily for 5 days, or trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days if local resistance rates are under 20%, as recommended by the most recent guidelines 1. The choice of antibiotic should be based on the patient's medical history, potential allergies, and local resistance patterns.
- Nitrofurantoin is a good option due to its minimal resistance and efficacy comparable to trimethoprim-sulfamethoxazole 1.
- Trimethoprim-sulfamethoxazole is also effective, but its use should be guided by local resistance rates, which should not exceed 20% 1.
- Fosfomycin (Monurol) 3g single dose is another effective option, with minimal resistance and propensity for collateral damage 1. For patients with complicated factors or allergies, fluoroquinolones like ciprofloxacin 250mg twice daily for 3 days can be used, though they're generally reserved as second-line due to resistance concerns and side effects 1. Beta-lactams such as amoxicillin-clavulanate 875/125mg twice daily for 5-7 days are less preferred but useful when other options aren't suitable 1. Patients should complete the full course even if symptoms improve quickly, drink plenty of fluids, and seek follow-up if symptoms persist after 48-72 hours of treatment. These recommendations target the most common UTI pathogens like E. coli while balancing efficacy, resistance patterns, and minimizing collateral damage to normal flora 1.
From the FDA Drug Label
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 recommended dosage for women 18 years of age and older for uncomplicated urinary tract infection (acute cystitis) is one sachet of fosfomycin tromethamine granules for oral solution
The recommended antibiotics for outpatient treatment of Urinary Tract Infections (UTI) are:
- Trimethoprim-sulfamethoxazole (2): 1 DS tablet every 12 hours for 10 to 14 days
- Fosfomycin (3): one sachet of fosfomycin tromethamine granules for oral solution for uncomplicated urinary tract infection (acute cystitis)
From the Research
Recommended Antibiotics for Outpatient Treatment of UTI
The following antibiotics are recommended for the outpatient treatment of Urinary Tract Infections (UTI):
- Nitrofurantoin for 5 days 4, 5, 6, 7, 8
- Fosfomycin in a single dose 4, 5, 6, 7, 8
- Pivmecillinam for 5 days 4, 5, 6
- Trimethoprim for 3 days 7, 8
- Trimethoprim/sulfamethoxazole for 3 days 7, 8
Second-Line Options
Second-line options include:
- Oral cephalosporins such as cephalexin or cefixime 4
- Fluoroquinolones 4, 8
- β-Lactams such as amoxicillin-clavulanate 4, 8
Treatment Options for Specific Cases
Treatment options for UTIs due to specific cases 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