Which antibiotics are the best treatment for urinary tract infections (UTIs)?

UTI severity, side effects and bacteria strain decide which antibiotic will be the right choice for your UTI

Against what kind of UTI will antibiotics be effective?

UTIs are very common, with some 150 million cases recorded globally in a normal year. Over 90% of patients are women and the ages most at risk are 15 to 35 and any age older than 50. Doctors differentiate between simple UTI, which is an acute cystitis (bladder infection), and complicated UTI which includes chronic UTI, pregnancy-related UTI, post-surgery UTI, UTI in patients older than 65, and any UTI where the infection has already advanced to the kidneys. Complicated UTI often need more than just antibiotics to be successfully treated.

However, for a simple, acute UTI (i.e., it has only lasted for less than 10 days) antibiotics can be all it takes to effectively treat the infection.

What UTI antibiotics are there?

You can’t pick an antibiotic on your own, because they are prescription drugs. When your doctor chooses an antibiotic to treat your UTI, she’ll try to weigh the expected effectiveness of the drug against its possible side effects. If you only have mild symptoms and the bacteria can easily be eradicated, the doctor will try to minimize side effect risk. In the U.S. market the following FDA-approved antibiotics are available for treating UTI:

  • Macrobid (nitrofurantoin) is a popular choice of doctors, as its side effects are mild to moderate and because it does a good job a precisely targeting UTI bacteria, leaving the good bacteria in your body intact. Moreover, nitrofurantoin is deemed a relatively safe choice for pregnant women in the 2nd and 3rd trimesters. 
  • Cipro (ciprofloxaxin) used to be the most prescribed antibiotic treatment for UTI, but, as often is the case with long-running antibiotics, bacteria have learned to cope with it, i.e., they’ve become more resistant against it. Moreover, side effects of ciprofloxaxin can be serious, including tendon rupture and heart problems. It therefore no longer is a popular choice for treating simple UTI, but when the UTI has caused a kidney infection the drug is still used because it more easily gets to the kidneys than other antibiotics.
  • Bactrim is a combination of two antibiotics: trimethoprim and sulfamethoxazole. It’s sort of an all-purpose antibiotic that treats everything from bronchitis and ear infections to simple UTI. It has a long track record going for it and side effects generally are mild to moderate.
  • Keflex (cephalexin) is the newcomer in the list. Traditionally used to treat infections of the ears, skin and respiratory tract, this antibiotic in recent years has become more popular for UTI treatment, especially when there’s a kidney infection or the risk of it happening. It stepped in to fill the void left by cirpofloxaxin.  
  • Monurol (fosfomycyin) is an antibiotic that specifically targets bladder infections or other forms of simple UTI as well as prostate infections. It won’t help against bacterial infections in the kidneys, though.

Now you know the most common UTI antibiotics. Your doctor will help you choose the best treatment option for your specific UTI case. Aside from considering the intensity level of your UTI and the side effects, another consideration that is becoming increasingly important is bacteria’s drug resistance against UTI. 

In many U.S. hospitals it’s common now to test which bacteria strain is causing the UTI in order to assign the antibiotic that works most effectively against it, i.e., that the bacteria is the least resistant against. The NYC Department of Health even launched a mobile app that allows doctors to view a list of UTI strains and which antibiotics they are resistant to. So, when you suffer from an UTI, make sure to ask your doctor to test the bacteria strain. That will ensure that the most appropriate antibiotic will be prescribed to you.  

  
References:

Pujades-Rodriguez, Mar, et al. “Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-Prescription in Primary Care.” EClinicalMedicine, vol. 14, Sept. 2019, pp. 23–31, www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30120-8/fulltext, 10.1016/j.eclinm.2019.07.012. Accessed 27 Jan. 2020.

CDC. “Antibiotic Treatments for Urinary Tract Infections Are Commonly Prescribed To Pregnant Women.” Centers for Disease Control and Prevention, 11 Jan. 2018, www.cdc.gov/pregnancy/meds/treatingfortwo/features/kf-uti-antibiotic-treatments-pregnant-women.html. Accessed 27 Jan. 2020.

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