What antibiotics for streptococcal (strep) infections can also treat urinary tract infections (UTI)?

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Last updated: April 23, 2025View editorial policy

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From the Guidelines

Amoxicillin is the most appropriate antibiotic for treating both strep throat and urinary tract infections (UTIs) due to its broad-spectrum activity and relatively low resistance rates, as recommended by the European Association of Urology guidelines 1. When considering antibiotics for strep throat that can also treat UTIs, several options are available.

  • Amoxicillin, a penicillin antibiotic, is commonly prescribed for strep throat at 500 mg three times daily for 10 days and may also work for uncomplicated UTIs.
  • Cephalexin (Keflex), a cephalosporin antibiotic, is effective for both conditions, typically dosed at 500 mg four times daily for 7-10 days.
  • Trimethoprim-sulfamethoxazole (Bactrim) works well for UTIs and can sometimes be used for strep throat, usually given as one double-strength tablet twice daily for 3-5 days for UTIs or 10 days for strep. However, the most recent guidelines from the European Association of Urology 1 suggest that amoxicillin can be used in combination with other antibiotics for complicated UTIs, making it a viable option for treating both strep throat and UTIs. It's essential to note that antibiotic selection should be based on specific bacterial sensitivity, patient allergies, and medical history, and patients should always consult a healthcare provider for proper diagnosis and treatment. The use of fluoroquinolones like ciprofloxacin is generally reserved for more resistant infections due to side effect concerns, as recommended by the European Association of Urology guidelines 1. In contrast, the guidelines from the Infectious Diseases Society of America 1 focus on the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and do not provide direct guidance on the treatment of strep throat or UTIs. Therefore, the recommendation to use amoxicillin for treating both strep throat and UTIs is based on the most recent and relevant guidelines from the European Association of Urology 1.

From the FDA Drug Label

Levofloxacin tablets are indicated for the treatment of uncomplicated skin and skin structure infections (mild to moderate) including abscesses, cellulitis, furuncles, impetigo, pyoderma, wound infections, due to methicillin-susceptible Staphylococcus aureus, or Streptococcus pyogenes. Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.

Antibiotics for strep that can treat UTI also:

  • Levofloxacin can be used to treat strep (Streptococcus pyogenes) and UTI (uncomplicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus) 2, 2.
  • Key points:
    • Levofloxacin is effective against Streptococcus pyogenes.
    • Levofloxacin is effective against Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus, which are common causes of UTI.

From the Research

Antibiotics for Strep that can Treat UTI

  • The treatment of urinary tract infections (UTIs) and strep infections requires careful consideration of the causative pathogens and their resistance patterns 3, 4, 5.
  • For UTIs, recommended first-line empiric antibiotic therapy includes nitrofurantoin, fosfomycin, and pivmecillinam 3, 5.
  • Amoxicillin-clavulanate is an alternative therapy for UTIs caused by ceftriaxone non-susceptible Enterobacterales, with clinical outcomes comparable to standard of care 6.
  • For strep infections, amoxicillin-clavulanate is a broad-spectrum antibacterial agent that has been used for over 20 years, with a favorable pharmacokinetic/pharmacodynamic profile and low propensity to select resistance mutations 7.

Treatment Options

  • Nitrofurantoin, fosfomycin, and pivmecillinam are recommended for uncomplicated UTIs 3, 5.
  • Amoxicillin-clavulanate may be used as an alternative therapy for UTIs caused by ceftriaxone non-susceptible Enterobacterales 6.
  • For strep infections, amoxicillin-clavulanate is a suitable option, particularly for community-acquired respiratory tract infections 7.

Resistance and Treatment Considerations

  • The rise of antibiotic-resistant pathogens, including ESBL-producing Enterobacteriales and carbapenem-resistant Enterobacteriales, complicates UTI treatment 3, 5.
  • Amoxicillin-clavulanate may be a useful alternative therapy for UTIs caused by resistant pathogens, but its use should be guided by local resistance patterns and patient-specific factors 6.
  • The development of new antimicrobial agents and the wise use of existing agents are crucial to combating antibiotic resistance 3, 5.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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