Amoxicillin Is Not Recommended for UTI Treatment Due to High Resistance Rates
Amoxicillin alone is no longer recommended for empiric treatment of urinary tract infections due to high resistance rates (median 75% of E. coli isolates resistant to amoxicillin). 1
First-line Treatment Options for UTIs
First-line antibiotics for uncomplicated UTIs should include:
These first-line agents are effective in treating UTI while being less likely to produce collateral damage than second-line agents 1
Why Amoxicillin Alone Is Not Recommended
- Global Antimicrobial Resistance Surveillance System (GLASS) data shows a median of 75% (range 45-100%) of E. coli urinary isolates are resistant to amoxicillin 1
- This high resistance rate has led multiple guidelines to remove amoxicillin from recommended options for empiric UTI treatment 1
- Even older studies from decades ago showed treatment failures with amoxicillin when the infecting organism was resistant 4
Amoxicillin-Clavulanate as an Alternative
- Amoxicillin-clavulanate is designated as a first-choice antibiotic for lower UTIs by the WHO Expert Committee 3
- The addition of clavulanic acid extends coverage to beta-lactamase producing organisms 3, 5
- Susceptibility of E. coli to amoxicillin-clavulanate remains generally high in both adults and children 1
- Microbiological cure rates of 84% one week after treatment have been reported with amoxicillin-clavulanate 5
Treatment Duration and Administration
- For uncomplicated UTIs, antibiotics should be prescribed for as short a duration as reasonable, generally no longer than seven days 1
- Single-dose therapy with amoxicillin has been studied historically but is not currently recommended due to resistance concerns 6
- Obtaining urine cultures prior to initiating treatment is recommended for recurrent UTIs to guide therapy 1
Special Considerations
- For upper UTIs (pyelonephritis and prostatitis), amoxicillin or amoxicillin-clavulanate are not recommended as first-line therapy 1
- Ciprofloxacin or ceftriaxone/cefotaxime are preferred options for pyelonephritis 1
- Local resistance patterns should always guide therapy selection, as resistance rates vary geographically 3
- Patient-initiated treatment (self-start treatment) may be offered to select patients with recurrent UTIs while awaiting urine cultures 1
Antibiotic Stewardship Considerations
- When treating UTIs, clinicians should follow principles of antibiotic stewardship by using the shortest effective duration of therapy 1
- For patients with recurrent UTIs, antibiotic stewardship is particularly important to prevent development of resistance 3
- Asymptomatic bacteriuria should not be treated with antibiotics except in specific populations (pregnant women, patients scheduled for urinary tract procedures) 1