What is the treatment for a simple Urinary Tract Infection (UTI)?

From the Guidelines

For a simple urinary tract infection (UTI), the standard treatment is a course of short-course antibiotics, such as 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.

Treatment Options

• Nitrofurantoin: 5-day course, which is effective in treating uncomplicated bacterial cystitis 1
• Trimethoprim-sulfamethoxazole (TMP-SMZ): 3-day course, which is also effective in treating uncomplicated bacterial cystitis 1
• Fosfomycin: single-dose treatment, which is a suitable option for uncomplicated bacterial cystitis 1

Additional Recommendations

• Drink plenty of water (at least 8 glasses daily) to help flush bacteria from your system
• Complete the entire antibiotic course even if symptoms improve quickly to prevent recurrence
• If symptoms worsen, include fever, back pain, or nausea, seek immediate medical attention as this could indicate the infection has spread to the kidneys

Prevention

• Urinate after sexual activity
• Wipe from front to back
• Avoid irritating feminine products The American College of Physicians recommends short-course antibiotics for the treatment of uncomplicated UTIs, which is supported by the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to empiric selection of therapy Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination

Treatment for simple UTI:

• The recommended treatment is a single effective antibacterial agent.
• Trimethoprim-sulfamethoxazole can be used to treat urinary tract infections due to susceptible strains of Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris 2.
• Ciprofloxacin can also be used to treat urinary tract infections, but the provided label does not specifically address simple UTI treatment 3.

From the Research

Treatment Options for Simple UTI

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 4.
• High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 4.
• Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 4.

Comparison of Treatment Options

• A randomized clinical trial compared the clinical and microbiologic efficacy of nitrofurantoin and fosfomycin in women with uncomplicated cystitis, and found that 5-day nitrofurantoin resulted in a significantly greater likelihood of clinical and microbiologic resolution at 28 days after therapy completion compared to single-dose fosfomycin 5.
• The study found that clinical resolution through day 28 was achieved in 70% of patients receiving nitrofurantoin vs 58% of patients receiving fosfomycin 5.

Guideline Concordance

• A retrospective observational study found that the overall concordance rate with Infectious Diseases Society of America guidelines for the treatment of uncomplicated urinary tract infections in women was 58.4%, and increased from 48.2% in 2015 to 64.6% in 2019 6.
• The study found that patients aged 18 to 29 years and 30 to 44 years had a statistically significantly higher likelihood of receiving guideline-concordant treatment than patients aged 45 to 75 years 6.
• Obstetricians-gynecologists and urologists had a statistically significantly higher likelihood of concordant treatment than all other specialties combined 6.

Pharmacological Properties

• The choice of agent for treating uncomplicated UTIs should be based on the pharmacokinetic characteristics of the molecule to optimize clinical benefit and minimize the risk of antibacterial resistance 7.
• The preferred drugs for treating uncomplicated UTIs are nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin trometamol, fluoroquinolones, and β-lactam agents 7.