What Is A Urinary Tract Infection
UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection .
Kidney infection is another type of UTI. Theyre less common, but more serious than bladder infections.
Which Antibiotic Should Be Used To Treat A Uti
There are multiple types of antibiotics used to treat urinary tract infections . Different treatments may be recommended in different areas of the country based on regional patterns of antibiotic resistance.
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, the 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.
Symptoms like burning and stinging while urinating will usually clear up in within one day 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.
More extensive diagnostic procedures or imaging tests like an X-ray may be required if you continue to have frequent UTIs.
Who Gets Urinary Tract Infections
Anyone can. But they’re more likely when you:
- Are a woman
- Have had UTIs before
- Have a condition that affects your bladder’s nerves
- Have been through menopause
- Are overweight
- Have something that blocks the passage of urine, such as a tumor, kidney stone, or an enlarged prostate
- Use a diaphragm or spermicide for birth control
- Have a catheter, a tube placed into the bladder to drain urine from the bladder into a bag outside the body
- Are a man who has sex with men, has HIV, or hasnât been circumcised
Most of these traits also raise the odds that a simple bladder infection may become a more serious kidney infection or turn into . For pregnant women, a kidney infection can lead to delivering a baby too early.
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Recurrent Urinary Tract Infections
Patients with three or more infections per year should be offered either continuous low-dose antibiotic prophylaxis, patient-initiated, or postcoital prophylaxis if the onset of infection is linked to sexual intercourse . Before a prophylactic regimen is chosen, a urine culture should be performed to determine the susceptibility of the pathogen. The duration of continuous prophylactic therapy is usually 6 months to a year. Unfortunately, within 6 months of discontinuing antibiotic prophylaxis, 40% to 60% of women develop a urinary tract infection, and prophylaxis must be resumed. Patient-initiated therapy at the onset of symptoms has been shown to be effective in young, healthy nonpregnant women. Short-course regimens have been advocated for patient-initiated therapy in compliant women with frequently recurring and symptomatic urinary tract infections. The major advantages of short-course therapy over continuous therapy are convenience and the avoidance of antibiotic toxicity symptomatic infections are not prevented, however. For postcoital prophylaxis, nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones taken within 2 hours after sexual intercourse have been shown to significantly reduce the incidence of recurrent cystitis.,
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Availability Of Data And Materials
The data that support the findings of this study are available from the KUHR database and NorPD, but restrictions apply to the availability for these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and provided permission is granted from the KUHR database and NorPD.
Treatment Options For Urinary Tract Infections
Ladies, if you think you have a urinary tract infection, you are probably right. One study found that women who self-diagnose a UTI are right 84% of the time.
You can apply this know-how to partner with your health care provider to pick the right treatment The go-to treatment of a UTI, which is caused by a bacteria, is antibiotics. Your questions about treatment decisions can make a difference, especially since antibiotic recommendations have shifted and not all doctors have changed their practices.
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Latest Antibiotics For Utis
- Vabomere is a combination carbapenem antibiotic and beta-lactamase inhibitor. Vabomere was first approved in August of 2017.
- Vabomere is used for the treatment of adult patients with complicated urinary tract infections due to susceptible Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae species complex.
- Vabomere is given as an intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
- Zemdri is an aminoglycoside antibacterial for the treatment of complicated urinary tract infections, including pyelonephritis. Zemdri was first approved in February of 2015.
- Zemdri is used against certain Enterobacteriaceae in patients who have limited or no alternative treatment options. Zemdri is an intravenous infusion, administered once daily.
See also: Treatment Options for UTIs
Diagnosis And Treatment Of Urinary Tract Infections In Children
BRETT WHITE, MD, Oregon Health and Science University, Portland, Oregon
Am Fam Physician. 2011 Feb 15 83:409-415.
Acute urinary tract infections are relatively common in children, with 8 percent of girls and 2 percent of boys having at least one episode by seven years of age. The most common pathogen is Escherichia coli, accounting for approximately 85 percent of urinary tract infections in children. Renal parenchymal defects are present in 3 to 15 percent of children within one to two years of their first diagnosed urinary tract infection. Clinical signs and symptoms of a urinary tract infection depend on the age of the child, but all febrile children two to 24 months of age with no obvious cause of infection should be evaluated for urinary tract infection . Evaluation of older children may depend on the clinical presentation and symptoms that point toward a urinary source . Increased rates of E. coli resistance have made amoxicillin a less acceptable choice for treatment, and studies have found higher cure rates with trimethoprim/sulfamethoxazole. Other treatment options include amoxicillin/clavulanate and cephalosporins. Prophylactic antibiotics do not reduce the risk of subsequent urinary tract infections, even in children with mild to moderate vesicoureteral reflux. Constipation should be avoided to help prevent urinary tract infections. Ultrasonography, cystography, and a renal cortical scan should be considered in children with urinary tract infections.
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Antibiotics Used For Complicated Utis
Before getting into how to best treat a complicated UTI, its important to understand which UTIs are considered complicated. Here are some guidelines:
- Urinary tract abnormalities are present
- Youre pregnant
- The patient is a child
- A comorbidity is present that increases risk of infection or treatment resistance, such as poorly controlled diabetes
- Youre a man, since most UTIs in men are considered complicated
- Youre elderly
Kidney infections are often treated as a complicated UTI as well, notes the Merck Manual.
If a UTI is complicated, a different course of antibiotics may be required. And the initial dose of antibiotics may be started intravenously in the hospital. After that, antibiotics are given orally at home. In addition, follow-up urine cultures are generally recommended within 10 to 14 days after treatment. Not all of the antibiotics approved for uncomplicated UTIs are appropriate for the complicated version. Some that are considered appropriate, include:
Treatment Of Bladder Urinary Tract Infections
The specific intervention depends on the severity of the symptoms. In many instances, healthy patients who have a urinary tract infection but have no symptoms require no treatment at all. Such asymptomatic UTIs typically resolve within two to three days.
If urinary tract infection symptoms are presentsuch as a burning sensation during urination or an increased need to urinatetreatment usually consists of antibiotic medications, which are prescribed for three to 14 days. They include:
- Trimethoprim: Trimethoprim is the standard treatment for urinary tract infections in otherwise-healthy adults. It is one of the more potent UTI antibiotics, so most patients only require a three-day course. Trimethoprim is generally well-tolerated with few side effects, which generally include nausea, vomiting, diarrhea/constipation or stomach pain.
- Nitrofurantoin: Nitrofurantoin is the second most commonly prescribed antibiotic for bladder UTIs. It usually requires a longer course than trimethroprim , and is usually well tolerated but should not be taken by anyone with kidney disease. Side effects include nausea and vomiting.
- Cephalosporins: Cephalosporins are often used as a first-line of treatment in patients that have upper urinary tract infections involving the ureters or kidneys. It is usually taken for seven to 10 days. Side effects include nausea, vomiting, upset stomach and diarrhea.
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Why Do Antibiotics Sometimes Not Work For A Urinary Tract Infection
If an antibiotic doesnt work it is likely that the bacteria causing the UTI is not susceptible or is resistant to the antibiotic you are taking.
Antibiotic resistance occurs when the bacteria that is causing the infection is no longer affected by a particular antibiotic and is able to continue to grow and multiply. Inappropriate and unnecessary antibiotic use contributes to the increasing problem of antibiotic resistance.
If you felt better for a little while and then came down with the symptoms of a UTI again, it is also possible that you have a new or recurrent UTI.
Another possibility if you continue to experience symptoms of a UTI despite antibiotic treatment, is that you have another type of infection that mimics that symptoms of a UTI and you need a different antibiotic or other treatment. Sexually transmitted infections such as chlamydia and gonorrhea, for example, produce symptoms that mimic a UTI. Vaginal yeast infections can also cause burning when you pee.
What Should I Do If My Antibiotic Doesnt Work For My Urinary Tract Infection
If your symptoms dont improve within a couple of days or get worse after starting an antibiotic you should contact your healthcare provider. A different antibiotic, a longer course of antibiotics or another treatment may be required. A physical exam or urine sample may be required.
When you have a UTI its important to:
- Only take an antibiotic that has been prescribed for you
- Take the antibiotic exactly as instructed by your healthcare provider and finish the full course of treatment even if you feel better
- Drink plenty of water and other fluids
- Urinate or pee regularly
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Urine Drug Concentration & Clinical Efficacy
Antimicrobial drugs must achieve an adequate urine concentration, which must be maintained for a sufficient time for a drug to be effective in treating UTI.16 It has been suggested that clinical efficacy is observed when the urine drug concentration is maintained at a concentration 4-fold higher than the isolates MIC throughout the time between doses.9
Experimental studies in rats have shown that the time for which the plasma drug concentration exceeds the isolates MIC correlates to the magnitude of bacterial colony count reduction the longer the time for which the drug concentration remained above the MIC, the lower the urine colony counts.12 Successful eradication of bacteria within the renal parenchyma or urinary bladder wall is correlated to the plasma, not urine, drug concentration.
When prescribing time-dependent antibiotics, shortening the interval between drug administration is the most effective method to allow the tissue/urine drug concentration to exceed the MIC for the majority of the dosing interval.
- Drug elimination follows first-order kinetics, where 50% of the drug is lost in 1 half-life.
- In contrast, doubling the dose would only add 1 half-life to the dosing interval.
- To add 2 half-lives to the dosing interval, the initial dose would have to be increased 4-fold. The peak serum drug concentration achieved by this approach may exceed the window of safety, producing adverse drug effects.
Population Health Research Capsule
What do we already know about this issue?
Previous studies have found overuse of antibiotics for urinary tract infections .
What was the research question?
To evaluate the appropriateness of antibiotic prescriptions for UTIs.
What was the major finding of the study?
Antibiotics were overused and inappropriate antibiotics were commonly prescribed for suspected UTIs.
How does this improve population health?
This study identified antibiotic misuse including overly broad antibiotics and overdiagnosis of UTIs, which can promote antimicrobial resistance.
Patients were categorized as having uncomplicated cystitis or pyelonephritis based on their ICD-10 code. In cases where the ICD-10 code CM N39.0 for urinary tract infection, site not specified was used, the authors categorized patients as having either cystitis or pyelonephritis based on medical chart documentation of symptoms, vital signs, physical exam, and provider impression. Patients were assigned to the pyelonephritis cohort if they had fever, flank pain, or costovertebral angle tenderness.
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Implications For Research And Practice
Based on the data we analysed, a pragmatic approach is required when considering prescribing long-term antibiotics in older patients with recurrent UTI. Although long-term antibiotics may reduce the risk of UTI recurrence in women, this benefit diminishes on cessation of treatment. Little is known about optimal prophylaxis period, long-term effects on health, risk of antibiotic resistant infections, effect in older men, effect in frail care home residents or impact on important patient-centred outcomes. These unknowns must be balanced against benefits and patient preferences.
Future research efforts on recurrent UTI should focus on improving the design and reporting of trials and developing a core set of outcomes to allow better synthesis of trial data. Antibiotic prophylaxis should be compared with non-antibiotic prophylaxis with some evidence of efficacy rather than those with little or poor evidence of efficacy. Researchers should address unanswered questions regarding long-term effects, duration of use, adverse effects and antibiotic resistance.
What About Cranberry Juice For Uti
Its a long-held belief that consuming cranberry juice may help prevent and treat urinary tract infections. While its true that cranberries contain an active ingredient that can prevent adherence of bacteria to the urinary tract, there is still no evidence that cranberry products can treat a UTI.
One of the reasons: Products like cranberry juice or cranberry capsules are not explicitly formulated with the same amount of PACs that have shown potential in lab studies. Moreover, a 2019 report in the Journal of Urology noted that the availability of such products to the public is a severe limitation to the use of cranberries for UTI prophylaxis outside the research setting.
In all, theres actually very little high-quality research on the topic of prevention. For instance, a 2016 study in The Journal of the American Medical Association, found that among female nursing home residents, daily consumption of cranberry capsules resulted in no significant prevention of UTIs.
While consuming cranberry juice or supplements is not considered a first-line treatment of urinary tract infections, in most cases, it cant hurt. After all, drinking plenty of liquids does dilute your urine and help spur more frequent urination, which flushes bacteria from the urinary tract. The exception: Those who are taking blood-thinning medication, such as warfarin, should not consume cranberry juice. And those with diabetes should be mindful of the high-sugar content of fruit juices.
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What Oral Antibiotics Are Used To Treat An Uncomplicated Uti In Women
The following oral antibiotics are commonly used to treat most uncomplicated UTI infections :
Your doctor will choose your antibiotic based on your history, type of UTI, local resistance patterns, and cost considerations. First-line options are usually selected from nitrofurantoin, fosfomycin and sulfamethoxazole-trimethoprim. Amoxicillin/clavulanate and certain cephalosporins, for example cefpodoxime, cefdinir, or cefaclor may be appropriate options when first-line options cannot be used.
Length of treatment for cystitis can range from a single, one-time dose, to a course of medication over 5 to 7 days. Kidney infections may require injectable treatment, hospitalization, as well as a longer course of antibiotic, depending upon severity of the infection.
Sometimes a UTI can be self-limiting in women, meaning that the body can fight the infection without antibiotics however, most uncomplicated UTI cases can be treated quickly with a short course of oral antibiotics. Never use an antibiotic that has been prescribed for someone else.
In men with symptoms that do not suggest a complicated UTI, treatment can be the same as women. In men with complicated UTIs and/or symptoms of prostatitis are not present, men can be treated for 7 days with a fluoroquinolone . Tailor therapy once urine cultures are available.
Can Urinary Tract Infections Be Prevented Or Avoided
There are many lifestyle choices that can help you prevent UTIs. These are some of the things you can do to protect yourself from them:
- Drink plenty of water to flush out bacteria. For some people, drinking cranberry juice may also help prevent urinary tract infections. However, if youre taking warfarin, check with your doctor before using cranberry juice to prevent urinary tract infections. Your doctor may need to adjust your warfarin dose or you may need to have more frequent blood tests.
- Dont hold your urine. Urinate when you feel like you need to. Some children dont go to the bathroom often enough. If your child does this, teach him or her to go to the bathroom several times each day.
- Wipe from front to back after bowel movements. Teach your child to wipe correctly.
- Urinate after having sex to help wash away bacteria.
- Use enough lubrication during sex. Try using a small amount of lubricant before sex if youre a little dry.
- If you get urinary tract infections often, you may want to avoid using a diaphragm as a birth control method. Ask your doctor about other birth control choices.
- Avoid taking or giving your child bubble baths.
- Wear loose-fitting clothing , and dress your child in loose-fitting clothing.
- If you are uncircumcised, wash the foreskin regularly. If you have an uncircumcised boy, teach him how to wash his foreskin.
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