3/1/2018 Antibiotics For UTI Treatment: What Are My Options? - Drugs.

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Antibiotics For UTI Treatment - What Are My Options?

Medically reviewed on Sep 20, 2016 by L. Anderson, PharmD.

Have you experienced a urinary tract infection?

If you have ever experienced the frequent urge to go the bathroom with painful burning urination, you have probably
experienced a urinary tract infection (UTI). You may be surprised to know that UTIs are the second most common type of
infection in the body, accounting for over 8 million visits to health care providers each year. Sometimes a UTI can be self-
limiting, meaning that your body can fight the infection without antibiotics; however, most uncomplicated UTI cases can be
treated quickly with a short course of oral UTI antibiotics.

What is a urinary tract infection (UTI)?

A UTI infection can happen anywhere along your urinary tract, which includes the kidneys (the organ that filters the blood to
make urine), the ureters (the tubes that take urine from each kidney to the bladder), the bladder (stores urine), or the urethra
(the tube that empties urine from the bladder to the outside).

A lower urinary tract infection occurs when bacteria gets into the urethra and is deposited up into the bladder -- this is called
cystitis. Infections that get past the bladder and up into the kidneys are called pyelonephritis . An infection of the tube that
empties urine from the bladder to the outside is called urethritis. UTI symptoms in women and men are similar.

Urinary tract infection symptoms may include:

Pain or burning upon urination

A frequent or urgent need to urinate
Blood in the urine or a cloudy or pink-stained urine
Pain, cramping in the lower stomach

Upper UTIs which include the kidney may also have symptoms of fever, back pain, and nausea or vomiting.

Urinary tract infections occur more frequently in women than in men because a woman’s urethra is shorter and closer to the
anus than in men, allowing easier entry of bacteria into the urethra. Women are also more likely to get an infection after
sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI.

Which antibiotic should be used to treat a UTI?

There are multiple types of antibiotics used to treat urinary tract infections (UTIs). Most UTIs (75-95%) in women are caused
by a bacteria known as Escherichia coli (E. coli). Other Enterobacteriaceae types of bacteria may infrequently be present.
Different treatments may be recommended in different areas of the country based on regional patterns of drug resistance, so
it’s important to consider these effects, even with E. Coli.

Most patients with an uncomplicated UTI will begin treatment without any special diagnostic test, although a urinalysis may
be performed by taking a urine sample. In a urinalysis, chemical components of the urine are determined, and the doctor may
look at urine color, clarity, and a view a sample under the microscope. A urine culture may be order, too, but is not always
needed to start treatment. A urine culture can define the specific bacteria causing the UTI, in more complicated cases, or in
the case of treatment failure.

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Symptoms like burning while urinating will usually clear up in within one to two days after starting treatment. Be sure to finish
your entire course of medication. If symptoms are still present after 2 to 3 days, contact your healthcare provider

What oral antibiotics are used to treat an uncomplicated UTI?

The following oral antibiotics are commonly used to treat most UTI infections (acute cystitis):

Sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS, others)

Nitrofurantoin (Macrobid, Macrodantin)
Fosfomycin (Monurol)
Amoxicillin/clavulanate (Augmentin)
Certain cephalosporins like cefpodoxime, cefdinir, or cefaclor

The fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) have also been commonly used for
uncomplicated cystitis; however, July 2016 FDA recommendations strongly suggest that the fluoroquinolone class be
reserved for more serious infections, and only be used if other appropriate antibiotics are not an option.

An FDA safety review found that both oral and injectable fluoroquinolones (also called "quinolones") are associated with
disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. These adverse effects can
occur soon after administration to weeks after exposure, and may potentially be permanent. Patients should discuss the use
of fluoroquinolones with their healthcare provider.

However, the oral fluoroquinolones are appropriate for more complicated UTIs, including pyelonephritis. For the outpatient
treatment of uncomplicated pyelonephritis, the following quinolones are typically be used:

Ciprofloxacin (Cipro, Cipro XR)

Levofloxacin (Levaquin)

Are intravenous (IV) antibiotics used for a complicated UTI?

If you are pregnant, have a high fever, or cannot keep food and fluids down, your doctor may admit you to the hospital so
you can have treatment with intravenous (IV) antibiotics for UTI. You may return home and continue with oral antibiotics
when your infection starts to improve.

In areas with fluoroquinolone resistance exceeding 10 percent, in patients with more severe pyelonephritis, those with a
complicated UTI who have allergies to fluoroquinolones, or are unable to tolerate the drug class, intravenous therapy with an
agent such as ceftriaxone, or an aminoglycoside, such as gentamicin or tobramycin, may be appropriate. Your ongoing
treatment should be based on susceptibility data received from the laboratory.

Ceftriaxone (Rocephin)
Gentamicin
Tobramycin

Common side effects with antibiotic use

Each antibiotic is responsible for its own unique list of side effects, and the list is usually extensive. Be sure to discuss your
individual antibiotic side effects with your healthcare provider. However, there are side effects that are common to most
antibiotics, regardless of class or drug:

Vaginal yeast infections or oral thrush (candida species): Antibiotics may also change the normal flora balance in the
vagina, and lead to a fungal overgrowth. Candida albicans is a common fungus normally present in small amounts in the

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vagina and does not usually cause disease or symptoms. However, vaginal candidiasis may occur when there is limited
competition from bacteria due to antibiotic treatment.
 
Abdominal (stomach) upset: Antibiotics are frequently linked with stomach upset such as nausea, vomiting, lack of
appetite (anorexia), stomach pain, or heartburn (dyspepsia). Taking with food or a meal may help to decrease stomach
upset, but check with your pharmacist.
 
Antibiotic-associated diarrhea: Antibiotics may commonly lead to uncomplicated antibiotic-associated diarrhea or loose
stools, that will clear up after the antibiotic is stopped. Broad-spectrum antibiotics can also kill the normal gut flora
(“good bacteria) and lead to an overgrowth of infectious bacteria, such as Clostridium difficile (C. difficile). If the diarrhea
is severe, bloody, or is accompanied by stomach cramps or vomiting, a physician should be contacted to rule out C.
difficile. The most common antibiotics implicated in antibiotic-associated diarrhea are amoxicillin-clavulanate, ampicillin,
and cephalosporins, fluoroquinolones, azithromycin, and clarithromycin.
 
Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN): Stevens-Johnson syndrome (SJS) and toxic
epidermal necrolysis (TEN) are rare but serious allergic drug reactions. Skin reactions like rash, skin peeling, and mucous
membranes sores can occur and  may be life-threatening. Antibiotics such as sulfonamides, penicillins, cephalosporins,
and fluoroquinolones may result in SJS and TEN.

What about antibiotic resistance?

Resistance rates for antibiotics are always variable based on local patterns in the community and specific risk factors for
patients, such as recent antibiotic use or travel.

High rates of antibiotic resistance are being seen with both ampicillin and amoxicillin for cystitis (E. coli), although
amoxicillin/clavulanate (Augmentin) may still be an option. Other oral treatments with reported increasing rates of resistance
include sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS) and the fluoroquinolones. Resistance rates for the oral
cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.

What new antibiotics are available for UTIs?

The latest FDA antibiotic approvals for UTIs include:

Avycaz

Avycaz (avibactam and ceftazidime) is a next generation, non-β lactam β-lactamase inhibitor and third-generation,
antipseudomonal cephalosporin antibiotic combination for the treatment of complicated intra-abdominal infections in
combination with metronidazole and complicated urinary tract infections (UTIs), including pyelonephritis, in those who
have limited or no alternative treatment options.
Avycaz was first approved on February 25th, 2015 and is manufactured by Allergan Inc. Avycaz is given as an intravenous
infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.

Zerbaxa

Zerbaxa (ceftolozane and tazobactam) is a cephalosporin and beta-lactamase inhibitor combination for the treatment of
complicated intra-abdominal infections and used with metronidazole. Zerbaxa is also used for complicated urinary tract
infections (cUTI), including pyelonephritis.
Zerbaxa was first approved on December 19th, 2014 and is manufactured by Merck and Co. Zerbaxa is given as an
intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney
impairment.

See also: More treatment options....

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Are there any over-the-counter antibiotics for UTIs?

Over-the-counter antibiotics for a UTI are not available. Your provider may recommend an OTC product called Uristat
(phenazopyridine) to numb your bladder and urethra to ease the burning pain during urination. Uristat can be bought
without a prescription at the pharmacy. A similar phenazopyridine product called Pyridium is also available with a prescription
from your doctor. Take phenazopyridine for only 48 hours, and be aware it may cause your urine to turn a brown, orange or
red color which may stain fabrics or contact lenses. It may be best to not wear contact lenses while being treated with
phenazopyridine.

See also: Ratings of Urinary Anti-Infectives

What if I have frequent, recurring UTIs?

Some women may have 2 or 3 UTIs in a year; for these women antibiotic prophylaxis may be recommended by her health
care provider. For recurrent UTIs, there are several options:

A shorter course (3 days) of antibiotics at the first sign of UTI symptoms; a prescription may be given to you to keep at
home.
A longer course of antibiotic therapy.
Take a single dose of an antibiotic after sexual intercourse.

The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost.
Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, cephalexin,
or norfloxacin.

In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective
treatment.

Can I treat a UTI without antibiotics?

UTI treatment without antibiotics is NOT usually recommended. An early UTI, such as a bladder infection (cystitis), can worsen
over time, leading to a more severe kidney infection (pyelonephritis). However, a small study has suggested early, mild UTIs
might clear up on their own. It's always best to check with your doctor if you are having UTI symptoms. Pregnant women
should always see a doctor as soon as possible if they suspect they might have a UTI, as this can lead to a greater risk of
delivering a low birth weight or premature infant.

Does cranberry juice prevent a UTI?

Some patients may want to use cranberry or cranberry juice as a home remedy to treat a UTI. Cranberry juice has not been
shown to cure an ongoing bacterial infection in the bladder or kidney.

Cranberry has been studied as a preventive maintenance agent for UTIs. According to one expert, the active ingredient in
cranberries -- A-type proanthocyanidins (PACs) -- is effective against UTI-causing bacteria, but is only in highly concentrated
cranberry capsules, not in cranberry juice. Cranberry seems to work by preventing bacteria from sticking to the inside of the
bladder; however, it would take a large amount of cranberry juice to prevent bacterial adhesion. In addition, cranberry was
not proven to prevent recurrent UTIs in well-controlled studies, as seen in a 2012 meta-analysis of 24 studies published by the
Cochrane database. Previous studies suggested cranberry or cranberry juice might have been useful to prevent UTIs.

The effectiveness of many herbal or home remedies may not have been scientifically tested to the same degree as
prescription medications -- or at all. Over-the-counter herbal products and dietary supplements are not regulated by the FDA.
Side effects and drug interactions may still occur with alternative treatments. Always check with your health care professional
before using an alternative treatment, herbal or dietary supplement for any condition. In most cases, an antibiotic is the best
treatment for a UTI.

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More Resources:
More Topics under Urinary Tract Infection:

Bladder Infection
Kidney Infections
Urinary Acidification
Urinary Alkalinization

Micromedex® Care Notes:

Urinary Tract Infection In Children

Urinary Tract Infection In Men
Urinary Tract Infection In Women

Symptom Checker:

Difficulty Passing Urine

Loss of Control of Urine in Women
Painful or Frequent Urination in Men

See Also
Acute Bronchitis in Adults
Alcohol and Antibiotics
Antibiotic Resistance
Antibiotic Shortages: A Serious Safety Concern
Antibiotics - Common Side Effects, Allergies and Reactions
Antibiotics and Birth Control Pill Interactions
Top 10 FAQs for Middle Ear Infections in Children
Why Don’t Antibiotics Kill Viruses?

Sources

1. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.
2. Hooton T, et al. Acute uncomplicated cystitis and pyelonephritis in women. Up To Date. May 26, 2016. Accessed September 19, 2016.
3. Hooton T, et al. Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics). May 29, 2015. Accessed September 19, 2016 at
https://www.uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics

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