What should I do if my pharmacy never refilled my prescription for a urinary tract infection (UTI) antibiotic and it's been a week?

Immediate Action Needed for Untreated UTI

You should contact your healthcare provider immediately or visit an urgent care facility as a week without antibiotic treatment for a UTI increases your risk of developing pyelonephritis (kidney infection). 1

Why Immediate Action is Necessary

• Untreated UTIs can progress to pyelonephritis, with studies showing a significantly higher risk (3.6% vs 0.4%) of developing pyelonephritis or febrile UTI in patients who don't receive immediate antibiotics 1
• The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines specifically recommend against withholding antibiotics in patients with a diagnosis of cystitis 1
• While some UTI symptoms may resolve without antibiotics (39-58% achieve symptom resolution by day 3-4), the risk of progression to more serious infection increases with delayed treatment 1

Steps to Take Now

1. Contact your prescriber immediately to inform them that your prescription was never filled 2
2. Visit an urgent care center or emergency department if you cannot reach your prescriber and symptoms are worsening (fever, back pain, nausea, vomiting) 1
3. Request a new prescription to be sent to a different pharmacy if the original pharmacy failed to fill it 2

Symptom Assessment

• Worsening symptoms requiring immediate care:

  • Fever (>100.4°F/38°C)
  • Back or flank pain
  • Nausea or vomiting
  • Chills or shaking
  • Feeling very ill 1

• Typical UTI symptoms that should still be treated:

  • Dysuria (painful urination)
  • Urinary frequency or urgency
  • Suprapubic pain
  • Cloudy or strong-smelling urine 1, 3

Treatment Considerations

• First-line antibiotics for uncomplicated UTIs include:

  • Nitrofurantoin for 5 days
  • Fosfomycin as a single dose
  • Trimethoprim-sulfamethoxazole for 3 days (if local resistance rates are <20%) 4, 3

• While some studies have explored symptomatic treatment with NSAIDs as an alternative to antibiotics, this approach is associated with:

  • Increased symptom burden
  • Higher risk of progression to pyelonephritis
  • Not recommended when antibiotics have already been prescribed but not filled 1

Prevention of Future Issues

• To avoid similar situations in the future:
  • Confirm that your prescription has been sent to the pharmacy before leaving your appointment 2
  • Call the pharmacy to verify they've received your prescription 2
  • Consider using a pharmacy app that allows you to track prescriptions 5
  • Ask for a paper prescription as backup if electronic prescribing fails 2

Important Cautions

• Do not attempt to self-treat with leftover antibiotics from previous prescriptions, as this can lead to inadequate treatment and antibiotic resistance 6, 5
• Do not delay seeking care further, as the risk of complications increases with time 1
• Be aware that while some UTIs may resolve without antibiotics, this is not recommended when a healthcare provider has already determined antibiotics are necessary 1, 3