What is the standard antibiotic (abx) given for a urinary tract infection (UTI)?

From the Guidelines

The standard antibiotic treatment for uncomplicated urinary tract infections (UTIs) is typically nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1.

Key Considerations

• The choice of antibiotic should target Escherichia coli, which accounts for more than 75% of all bacterial cystitis 1.
• Treatment duration is typically shorter for uncomplicated cystitis in women (3-5 days) and longer for men, pregnant women, or complicated infections (7-14 days) 1.
• Fluoroquinolones are highly efficacious but have a high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1.

Alternative Options

• For patients with allergies or contraindications to the recommended medications, alternatives include cephalexin (Keflex) 500mg four times daily for 7 days 1.
• Fosfomycin (Monurol) as a single 3-gram dose is also an option for uncomplicated cystitis 1.

Patient Advice

• Patients should complete the full course of antibiotics even if symptoms improve quickly 1.
• Drinking plenty of water and seeking medical attention if symptoms worsen or don't improve within 48 hours of starting treatment is crucial 1.

From the Research

Standard Antibiotics for Urinary Tract Infections (UTIs)

• The standard antibiotics given for a urinary tract infection (UTI) include:
  • Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days) 2
  • Nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5-7 days) 2, 3
  • Fosfomycin trometamol (3 g in a single dose) 2, 3, 4
• Fluoroquinolones, such as ciprofloxacin, are effective for clinical outcomes but should be reserved for more invasive infections 2, 3, 5
• β-Lactam agents, such as amoxicillin-clavulanate and cefpodoxime-proxetil, are not as effective as empirical first-line therapies 2, 3

Resistance and Treatment Options

• High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin have been reported, making them less suitable as empiric treatments for UTIs 3, 4, 6
• Nitrofurantoin and fosfomycin have been shown to be effective treatment options with low resistance rates 3, 4, 6
• Second-line options include oral cephalosporins, such as cephalexin or cefixime, and fluoroquinolones 3
• Treatment options for UTIs due to extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales include nitrofurantoin, fosfomycin, and carbapenems 3