Treatment of Urinary Tract Infection

Uncomplicated urinary tract infection – Treatment of uncomplicated urinary tract infection consists of oral antibiotics. These have an initial cure rate of approximately 90%.3  The most common regimen is a three day course of a combined antibiotic-sulfa drug called trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim). In patients with an allergy to sulfa or in areas where bacterial resistance to TMP-SMX is high, a three day course of a fluoroquinolone antibiotic (ciprofloxacin, Cipro) may be substituted. Additional first line antibiotic regimens include Nitrofurantoin (Macrobid) and Fosfomycin (Monural).5,6

Pyelonephritis (infection of the kidney) is typically treated with one dose of intravenous or intramuscular antibiotics at the doctor’s office or emergency room, followed by 7-14 days of oral antibiotics at home.5 Patients who are very sick, have other risk factors or demonstrate persistent symptoms may be admitted to the hospital for treatment.

Relapsing/recurrent urinary tract infection – Approximately 10% of women develop symptoms of another UTI within three weeks of initial treatment.1 This is considered a treatment failure, or relapse, and is treated with a longer course of antibiotics (usually 7-14 days).

A number of different strategies are employed to treat recurrent urinary tract infection (more than two UTIs per year). These include a continuous low dose of antibiotics (referred to as prophylaxis or preventative treatment). Under the guidance of their doctors, women may also self-administer a preventative dose of antibiotics after intercourse, or start a three-day course of treatment when UTI symptoms arise.7 For both relapsing and recurrent infections, imaging tests may be useful to exclude underlying anatomic abnormalities that could be increasing the risk of infection.2

Complicated urinary tract infection – Patients with complicated urinary tract infections typically receive more aggressive treatment, including an initial 7-14 day course of antibiotics. Obtaining a urine culture is more important in these patients, because they have a higher likelihood of infection with resistant strains of bacteria or bacteria other than e.coli.1 Some women may benefit from continuous, low-level antibiotic prophylaxis, particularly those with urinary catheters.4  If there is an underlying anatomic problem with the kidneys or bladder, this may need to be corrected to decrease the risk of future infections