From the Guidelines
Uncomplicated Urinary Tract Infections (UTI) in women should be treated with short-course antibiotics, specifically nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose.
Recommended Antibiotics
- Nitrofurantoin: 100 mg twice a day for 5 days 1
- Trimethoprim-sulfamethoxazole (TMP-SMZ): 160/800 mg twice a day for 3 days, but avoid if resistance prevalence exceeds 20% or if used for UTI in the previous 3 months 1
- Fosfomycin: 3 gm single dose, but has lower efficacy than some other recommended agents and should be avoided if early pyelonephritis is suspected 1 The choice of antibiotic should be individualized based on patient allergy and compliance history, local practice patterns, local community resistance prevalence, availability, cost, and patient and provider threshold for failure 1.
Considerations
- The IDSA guidelines recommend considering alternate diagnoses, such as pyelonephritis or complicated UTI, and treating accordingly 1.
- Fluoroquinolones can be used, but their use is limited due to high resistance prevalence in some areas 1.
- Pivmecillinam can be used, but has lower efficacy than some other recommended agents and should be avoided if early pyelonephritis is suspected 1.
From the Research
Recommended Antibiotics for Uncomplicated UTI in Women
The following antibiotics are recommended for the treatment of uncomplicated urinary tract infections (UTI) in women:
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole (TMP/SMX)
- Fosfomycin
First-Line Antibiotic Treatments
According to the Infectious Diseases Society of America guidelines, the first-line antibiotic treatments for uncomplicated UTI in women are:
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole (TMP/SMX)
- Fosfomycin 2
Antibiotic Prescribing Practices
Studies have shown that fluoroquinolones are often overprescribed for uncomplicated UTI in women, despite guidelines recommending against their use due to antibiotic resistance and adverse events 3, 2, 4.
- A study found that fluoroquinolones were prescribed in 36.4% of visits for uncomplicated UTI, while nitrofurantoin and TMP/SMX were prescribed in 31.8% and 26.3% of visits, respectively 2.
- Another study found that fluoroquinolones were the most frequently prescribed antibiotics for uncomplicated UTI in women from 2002 to 2011, with older patients and those treated by internists being more likely to receive fluoroquinolones 4.
Non-Antibiotic Strategies
Non-antibiotic strategies, such as delayed prescription of antibiotics or placebo, have been investigated as alternatives to immediate antibiotic treatment for uncomplicated UTI in women 5, 6.
- A systematic review and individual participant data meta-analysis found that non-antibiotic strategies increased the rates of incomplete recovery, subsequent antibiotic treatment, and pyelonephritis, but decreased overall antibiotic use by 63% 6.
- Another study found that non-steroidal anti-inflammatory drugs (NSAIDs) probably result in less short-term resolution of symptoms and greater use of rescue antibiotics by day 30 compared to primary antibiotic treatment 5.