From the Guidelines
Doxycycline is not a recommended first-line treatment for urinary tract infections (UTIs) due to its lower efficacy compared to other antibiotics. The most recent and highest quality study, published in 2021 in the Annals of Internal Medicine 1, recommends short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose for women with uncomplicated bacterial cystitis. For men and women with uncomplicated pyelonephritis, the study recommends short-course therapy either with fluoroquinolones (5 to 7 days) or TMP–SMZ (14 days) based on antibiotic susceptibility. Another study published in 2019 in The Journal of Urology 1 also supports the use of first-line therapy such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin for the treatment of symptomatic UTIs in women. Key points to consider when treating UTIs include:
- Using first-line therapy dependent on the local antibiogram
- Treating recurrent UTI patients with as short a duration of antibiotics as reasonable, generally no longer than seven days
- Considering culture-directed parenteral antibiotics for patients with urine cultures resistant to oral antibiotics. It's essential to note that doxycycline may be prescribed for UTIs caused by certain susceptible bacteria, particularly when standard antibiotics cannot be used due to allergies or resistance patterns, but it is not the preferred choice due to its lower concentration in urine compared to other antibiotics.
From the FDA Drug Label
Doxycycline is indicated for treatment of infections caused by the following gram- negative microorganisms, when bacteriologic testing indicates appropriate susceptibility to the drug: ... Respiratory tract and urinary tract infections caused by Klebsiella species. Doxycycline is indicated for treatment of infections caused by the following gram-negative microorganisms: ... Escherichia coli.
Doxycycline may be used to treat some urinary tract infections (UTIs), specifically those caused by susceptible bacteria such as Escherichia coli and Klebsiella species. However, the effectiveness of doxycycline for UTIs depends on the bacteriologic testing indicating appropriate susceptibility to the drug 2.
From the Research
Treatment of UTIs with Doxycycline
- Doxycycline is an antibiotic that has been used to treat urinary tract infections (UTIs) 3.
- A study from 1980 compared the effectiveness of 4-day and 10-day courses of doxycycline for treating UTIs, and found that both treatment durations were effective in clearing the infection 3.
- However, doxycycline is not listed as a first-line treatment for UTIs in more recent guidelines, which recommend nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin as preferred treatments 4, 5.
- Other studies have focused on the treatment of UTIs with other antibiotics, such as fluoroquinolones, pivmecillinam, and cotrimoxazole, and have found varying rates of effectiveness and guideline concordance 5, 6, 7.
Guideline Concordance for UTI Treatment
- Studies have shown that there is often low concordance with guidelines for the treatment of UTIs, with fluoroquinolones being overused and first-line antibiotics being underused 5, 7.
- Patient and physician characteristics, such as age and specialty, can influence the choice of antibiotic and treatment duration 5, 7.
- Efforts to improve guideline concordance and reduce the misuse of antibiotics are needed to preserve the effectiveness of these medications and minimize the risk of antibiotic resistance 5, 7.