Medications for Urinary Tract Infections (UTI)
UTI Treatment: antibiotic therapy
Antibiotics are the main treatment for all UTIs. With antibiotic treatment the infection may improve within a couple of days, but 1 to 2 weeks of medication may be prescribed to prevent a kidney infection.
The choice of antibiotic depends on many factors, including whether the infection is complicated or uncomplicated, primary or recurrent. An appropriate antibiotic for treating UTI must be bactericidal and conform to the following general specifications:
- its pharmacology must include, in case of oral administration, rapid absorption and attainment of peak serum concentrations
- its excretion must be predominantly renal
- it must achieve high concentrations in the renal or prostate tissue
- it must cover the usual spectrum of enterobacteria with reasonable chance of being effective on an empirical basis.
Trimethoprim-Sulfamethoxazole (TMP-SMX).
A three-day course of trimethoprim-sulfamethoxazole, commonly called TMP-SMX
(Bactrim, Cotrim, Septra), is the standard therapy for uncomplicated urinary
tract infections, if the likelihood of TMP-SMX resistance is low. In areas
where the likelihood of TMP-SMX resistance is high (greater than 20%)
nitrofurantoin or a fluoroquinolone antibiotic is an appropriate choice.
TMP-SMX should not be used in patients allergic to sulfa drugs. Allergic reactions can be very serious. Trimethoprim (Proloprim, Trimpex) is sometimes used alone in those allergic to sulfa drugs. TMP-SMX also interferes with the effectiveness of oral contraceptives.
Fluoroquinolones.
Fluoroquinolones are becoming a popular treatments for UTIs. These drugs
include ofloxacin (Floxin), norfloxacin (Noroxin), ciprofloxacin (Cipro),
levofloxacin (Levaquin), trovafloxin (Trovan).
Fluoroquinolones have excellent activity against a broad range of pathogens associated with UTI. It is recommended to take fluoroquinolones for 3 days for uncomplicated bladder infections. The course for 10 to 14 days is recommended for complicated bladder infections or kidney infections.
If possible, fluoroquinolones are not used as first-line treatment of uncomplicated UTIs in order to preserve their effectiveness for complicated UTIs. In general, these antibiotics are used in the following circumstances:
- In patients with complicated or catheter-induced UTIs
- In patients who do not respond or who are allergic to TMP-SMX
- In communities where there are high rates of bacteria resistant to TMP-SMX
- In elderly patients.
However, according to a 2006 study in the Archives of Internal Medicine, fluoroquinolone antibiotics such as ciprofloxacin have overtaken TMP-SMX as a first-line treatment for UTIs. Doctors are prescribing more fluoroquinolones due to increasing antibiotic resistance to sulfa antibiotics such as TMP-SMX.
Penicillins (Amoxicillin).
Until recent years, the standard treatment for a UTI was 10 days of amoxicillin,
a penicillin antibiotic. But now it is ineffective against E. coli bacteria
in up to 25% of cases. A combination of amoxicillin-clavulanate (Augmentin)
is sometimes given for drug resistant infections.
Cephalosporins.
Antibiotics known as cephalosporins, either second generation (cefuroxime
axetil, cefaclor, cefprozil) or third generation (cefixime, cefotaxime,
cefpodoxime) are also alternatives for infections that do not respond
to standard treatments. Cephalosporins are pregnancy category B drugs,
and a seven-day therapy can be considered as a second-line therapy for
pregnant women.
Patients with pyelonephritis can be treated with oral antibiotics or intramuscular doses of cephalosporins. Medications are given for 10-14 days, and sometimes longer. If the patient requires hospitalization because of high fever and dehydration caused by vomiting, antibiotics can be given intravenously.
Tetracyclines.
Long-term treatment with tetracycline or doxycycline may be used for infections
that are caused by Mycoplasma or Chlamydia.
Nitrofurantoin.
Nitrofurantoin (Furadantin, Macrodantin) is a relatively inexpensive antibiotic
that is used specifically for urinary tract infections. It is an effective
alternative to TMP-SMX or a fluoroquinolones. However, unlike many of
the other drugs it must be given 7 to 10 days, even in cases of simple
cystitis.
It should not be used in patients with kidney disease. It interacts with many drugs and other chronic or serious medical conditions may also affect its use. It should not be used in pregnant women within a week or two of delivery or in nursing mothers.
Fosfomycin.
The antibiotic fosfomycin (Monurol) is proving to be another good alternative.
It can be an effective one-dose treatment for many women, including those
who are pregnant. Bacterial resistance rates to this antibiotic are very
low.
Symptoms treatment
Although most urinary tract infections are not serious, they are painful. Antibiotics successfully treat urinary tract infections, but severe symptoms can persist for several days until treatment effectively eliminates the bacteria. A number of options are available for treating symptoms until the antibiotics are effective. It should be noted that all of these medications treat only symptoms and are not cures. They should never be used to replace antibiotics.
Phenazopyridine (Barodium, Eridium, AZO Standard) is a urinary tract pain reliever. This drug relieves pain and burning caused by the infection. It should not be taken for more than two days and should be discontinued when symptoms are relieved. Side effects include headache and stomach distress. The drug turns urine a red or orange color, which can stain fabric and be difficult to remove. In rare cases, it can cause serious side effects, including shortness of breath, bluish skin, sudden reduction in urine output, confusion.
Drugs that reduce bladder spasms include methenamine (Atrosept, Prosed, Urised) or flavoxate (Urispas). These agents can have severe side effects that the patient should discuss with the physician.
Over-the-counter pain relievers (acetaminophen, ibuprofen) and a heating pad may be used to relieve discomfort caused by UTI.
Self-care tips
- Drink plenty of liquids. Drinking plenty of water helps to cleanse bacteria out of the urinary tract and keep your urinary system flushed. Cranberry juice increase the acidity of urine, which helps prevent growth of bacteria. However, don't drink cranberry juice if you're taking the blood-thinning medication warfarin. Possible interactions between cranberry juice and warfarin can lead to bleeding.
- Avoid alcohol, coffee, black tea, chocolate, milk, carbonated beverages and citrus juices. They can irritate your bladder and tend to aggravate your frequent or urgent need to urinate. Urologists often recommended elimination of these beverages if recurrent infections are a problem.
- Use a heating pad. Sometimes a heating pad placed over the
abdomen can help minimize feelings of bladder pressure or pain.
- Urinate promptly when the urge arises. Avoid retaining your urine for a long time after you feel the urge to void.
- Wipe from front to back. Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
- Urinate before and after sexual intercourse. Also, drink a full glass of water to help flush bacteria.
- Keep the genital and anal areas clean before and after sex.
- Avoid potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
- Change sanitary pads and tampons frequently during menstruation.
- Don't use perfumed toilet paper, heavily scented soaps or powders in the vaginal area.
- Take showers rather than bubble baths.
- Wash the skin around the vagina and anus daily.
- Wear cotton underwear and loose-fitting clothes so that air can keep the area dry. Avoid tight-fitting jeans and nylon underwear, which trap moisture and can help bacteria grow.
- Unlubricated condoms or spermicidal condoms increase irritation and help bacteria cause symptoms. Consider switching to lubricated condoms without spermicide or using a nonspermicidal lubricant.