What is the treatment for urine leakage and bladder infection?

Treatment for Urine Leakage and Bladder Infection

For bladder infections (uncomplicated cystitis), first-line treatment is nitrofurantoin 100 mg twice daily for 5 days, fosfomycin trometamol 3 g single dose, or trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days in women; men require trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days minimum. 1, 2

Acute Bladder Infection Treatment

For Women with Uncomplicated Cystitis

First-line antibiotic options include: 1

• Nitrofurantoin 100 mg twice daily for 5 days 1
• Fosfomycin trometamol 3 g single dose 1
• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days 1, 3

Alternative options when first-line agents cannot be used: 1

• Cephalosporins (e.g., cefadroxil 500 mg twice daily for 3 days) if local E. coli resistance is <20% 1
• Trimethoprim 200 mg twice daily for 5 days 1

Important consideration: Fluoroquinolones should be avoided as first-line therapy due to resistance concerns and serious safety issues including tendon, muscle, and nerve damage 1, 4

For Men with Bladder Infection

Men require longer treatment duration due to potential prostatic involvement: 2

• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 7 days is first-line 2
• Extend to 14 days if prostatitis cannot be excluded 2
• Fluoroquinolones (ciprofloxacin 500 mg twice daily or levofloxacin 750 mg once daily for 7-14 days) are alternatives when trimethoprim-sulfamethoxazole cannot be used 2

Critical step: Obtain urine culture before starting antibiotics in men to guide therapy adjustments 2

Recurrent Urinary Tract Infections (≥3 infections/year or ≥2 in 6 months)

Non-Antibiotic Prevention Strategies (Preferred First)

These should be attempted before continuous antibiotic prophylaxis: 1

• Vaginal estrogen (rings, inserts, or cream) for postmenopausal women—highly effective at reducing recurrent UTIs by restoring vaginal microbiome 1
• Cranberry products containing ≥36 mg proanthocyanidin daily 1
• Methenamine hippurate 1 g twice daily—antimicrobial-sparing option for patients without incontinence 1
• Increased water intake by additional 1.5 L daily 1

Antibiotic Prophylaxis for Recurrent UTI

When non-antibiotic measures fail, consider: 1, 5

• Continuous prophylaxis: Trimethoprim-sulfamethoxazole 40/200 mg once daily or three times weekly 1, 5
• Alternative continuous prophylaxis: Nitrofurantoin 50-100 mg daily 1, 5
• Post-coital prophylaxis: Trimethoprim-sulfamethoxazole 40/200 mg or 80/400 mg once after intercourse 1

Evidence shows: Patients receiving continuous prophylaxis experience significantly fewer UTI episodes, emergency room visits, and hospitalizations 5

Addressing Urine Leakage

Urine leakage (incontinence) requires separate evaluation from infection treatment, though the two conditions may coexist. While the provided evidence focuses primarily on infection management, key considerations include:

• Ensure bladder emptying is optimized—incomplete emptying increases UTI risk 1
• For patients using intermittent catheterization: use single-use catheters only, never reuse 1
• Maintain adequate hydration (2-3 L daily unless contraindicated) to reduce UTI risk 1
• Consider anticholinergic medications to lower bladder pressure during acute UTI 1

Critical Pitfalls to Avoid

Do not use amoxicillin alone for empiric UTI treatment—global resistance rates show 75% of E. coli urinary isolates are resistant 1

Do not treat men with only 3-5 days of antibiotics—they require minimum 7 days due to complicated nature and potential prostatic involvement 2

Do not skip urine culture in men—this is essential for guiding therapy if initial treatment fails 2

Do not routinely prescribe antibiotic prophylaxis without first attempting non-antibiotic prevention strategies 1

Confirm infection eradication with negative urine culture 1-2 weeks after treatment before starting any prophylactic regimen 1