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 per year recorded globally on average. Over 90% of patients are female and the age groups most at risk are 15 to 35, and any age older than 50. Doctors differentiate between a 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 UTIs often require hospitalization for intervenous antibiotics.

For an acute, simple UTI, which has lasted less than 10 days, oral antibiotics are usully all it takes to effectively treat the infection.

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What antibiotics can be taken for a UTI?

You can’t pick an antibiotic on your own, because they are prescription drugs. When your doctor chooses an antibiotic to treat your UTI, they will try to weigh the effectiveness of the drug against its possible side effects. In the U.S. market, these are some of the available FDA-approved antibiotics for treating a UTI:

  • Macrobid (nitrofurantoin) is a popular choice, as its side effects are mild to moderate and because it does a good job of precisely targeting bacteria in the bladder, 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 (ciprofloxacin) used to be the most prescribed antibiotic treatment for UTIs, but, as often is the case with long-running antibiotics, bacteria have become more resistant against it. Moreover, side effects of ciprofloxaxin are rare but can be serious, including tendon rupture and heart rhythm problems. It is therefore no longer as popular for first-line treatment.  However, when a UTI travels to the kidneys, it is still used, as it more easily penetrates the kidneys than some other antibiotics.
  • Bactrim is a combination of two antibiotics: trimethoprim and sulfamethoxazole. It’s sort of an all-purpose antibiotic that treats everything from skin and ear infections to simple UTIs. It has a long track record going for it and side effects are generally mild to moderate.
  • Keflex (cephalexin) is traditionally used to treat infections of the ears, skin and respiratory tract.  In recent years it has become more popular for UTI treatment.
  • Monurol (fosfomycyin) is an antibiotic that specifically targets bladder or prostate infections. It won’t help against bacterial infections in the kidneys, though.  Fosfomycin can be helpful for some stubborn bacteria that does not respond to more common treatment, but is not commonly prescribed for uncomplicated infection.

Now you know some common antibiotics that are effective for treating a UTI.  Your doctor will help you choose the best treatment option for your specific case. Aside from considering the intensity level of your UTI and the side effects, another increasingly important consideration is bacterial drug resistance against common antibiotics. 

In hospitalized patients, urine cultures will be assessed to determine exactly which bacteria is causing the infection, and what antibiotics it will respond to.  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. Even with a simple UTI, determining the specific bacteria will ensure that the most appropriate antibiotic is prescribed.  


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,, 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, Accessed 27 Jan. 2020.

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