When You Need Themand When You Dont
Antibiotics are medicines that can kill bacteria. Doctors often use antibiotics to treat urinary tract infections . The main symptoms of UTIs are:
- A burning feeling when you urinate.
- A strong urge to urinate often.
However, many older people get UTI treatment even though they do not have these symptoms. This can do more harm than good. Heres why:
Antibiotics usually dont help when there are no UTI symptoms.
Older people often have some bacteria in their urine. This does not mean they have a UTI. But doctors may find the bacteria in a routine test and give antibiotics anyway.
The antibiotic does not help these patients.
- It does not prevent UTIs.
- It does not help bladder control.
- It does not help memory problems or balance.
Most older people should not be tested or treated for a UTI unless they have UTI symptoms. And if you do have a UTI and get treated, you usually dont need another test to find out if you are cured. You should only get tested or treated if UTI symptoms come back.
Antibiotics have side effects.
Antibiotics can have side effects, such as fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage.
Antibiotics can cause future problems.
Antibiotics can kill friendly germs in the body. This can lead to vaginal yeast infections. It can also lead to other infections, and severe diarrhea, hospitalization, and even death.
Antibiotics can be a waste of money.
When should older people take antibiotics for a UTI?
10/2013
What If I Have Frequent Recurring Utis
Within a year of havig a UTI infection, roughy one-quarter to one-half of women will have another UTI. For these women antibiotic prophylaxis may be recommended by her health care provider. With a recurrent course of UTIs, a urine culture or imaging tests may be required for further analysis.
For recurrent UTIs, there are several antibiotic options for prevention:
- A shorter course of antibiotics at the first sign of UTI symptoms a prescription may be given to you to keep at home.
- A longer course of low-dose antibiotic therapy.
- Take a single dose of an antibiotic after sexual intercourse.
The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost. Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, or cephalexin.
In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective treatment. Treatment options your doctor might recommend include: Estring, Vagifem , or vaginal estrogen creams .
First Line Antibiotics For A Uti
- Ampicillin
- Nitrofurantoin
- Trimethoprim/sulfamethoxazole
Notably absent from the list of antibiotics prescribed for the treatment of UTIs is Amoxicillin. While very popular and useful in treating numerous other bacterial infections, urinary tract infections are not amongst the infections Amoxicillin is used for.
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What Is The Best Antibiotic For Urinary Tract Infection
The urinary tract is comprised of the ureters , kidneys, bladder, and urethra . Urinary tract infections wake forest nc are most commonly located in the urethra and bladder and while typically caused by bacteria, UTIs can also be viral or fungal. For patients suffering from a bacterial UTI, they may be curious about what antibiotics are the best for treating their infection.
Antibiotics For Complicated Utis: What Drugs Do Doctors Prescribe For A Kidney Infection
A urinary tract infection can leave patients feeling drained and unwell, with even just the pain and burning sensation weighing down and causing fatigue. With a complicated UTI, the additional symptoms and difficulties faced can really affect everyday life. Many times, a complicated UTI goes beyond the typical bladder infection and enters the kidneys, meaning that its even more important to see a doctor and get the antibiotics required to kill the infection.
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Study Population And Data Collection
We conducted a retrospective observational cohort study, which was part of the baseline measurement of a cluster randomized controlled trial testing a multifaceted stewardship program to improve the appropriate use of antibiotics in patients with a complicated UTI in hospitals . The departments of internal medicine and urology of 19 university, teaching, and nonteaching hospitals located throughout the Netherlands participated. Included were adults who were admitted and diagnosed in 2007 or 2008 with a complicated UTI , and in whom antibiotic therapy was started. We defined a complicated UTI as a UTI with 1 of the following characteristics: male sex, any functional or anatomical abnormality of the urinary tract, pregnancy, immunocompromising disease or medication, or a UTI with symptoms of tissue invasion or systemic infection . Exclusion criteria were hospital-acquired UTIs , UTIs for which the Dutch national guideline does not provide a treatment recommendation , current treatment for another infection, transfer from/to another hospital, and direct admission to an ICU .
Between February and November 2009 the study researcher and a trained research assistant collected data from medical and nursing charts. QI performance was calculated for each patient using previously constructed algorithms. The ethics committee assessed the study and concluded that our study was deemed exempt from their approval.
Antibiotic Overuse Leads To Antibiotic Resistance
At some point, most people have taken a course of trimethoprim/sulfamethoxazole or ciprofloxacin , two common antibiotics used for UTIs. However, in the last few years it has become clear that the likelihood these antibiotics will kill most UTIs is dropping rapidly. You may have read the recent, frightening New York Timesarticle reporting one in three uncomplicated UTIs in young healthy women are Bactrim-resistant and one in five are resistant to five other common antibiotics. Pretty scary, since we used to feel confident that writing a prescription for Bactrim was a sure recipe for cure.
How is it that we are losing the antibiotic war with bacteria? Though many things drive bacterial resistance, giving antibiotics to animals and antibiotic overuse in humans top the list.
We use a lot of antibiotics in humans too much, and not always for the right reasons. When we prescribe antibiotics for viral illnesses like a cold, the flu, or common sinusitis, we create a massive shift in the bodys bacteria for no good reason .
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Treatment For Complicated Utis
If your UTI is considered complicated due to extenuating circumstances, your doctor will likely still prescribe an antibiotic, but your course of treatment may be different. For example, while UTIs are common during pregnancy especially in the lower urinary tract pregnant women typically require a longer course of treatment, regardless of which type of antibiotic is used. The antibiotics prescribed vary according to which trimester the expectant mother is in, too. TMP, for instance, isnt used during the first trimester.
In short, if your UTI is informed by extenuating circumstances, expect your physician to take those into account as he or she determines what antibiotics may be the safest and most effective, as well as how long you need to take them.
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.
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What Is The Most Effective Antibiotic For Uti
While mild UTIs usually go away on their own with sufficient hydration, most cases of moderate or recurrent UTIs may require medical treatment involving antibiotics and painkillers.
In order to determine what type of antibiotic you need, a urine sample is needed to identify the type of bacteria infecting your urinary tract. A urine culture is conducted on the sample, examining it for antibiotic sensitivity and specificity. It may take 3-4 days to get the results.
Doctors do not recommend taking a broad-spectrum antibiotic without a urine culture because doing so may contribute to antibiotic resistance, where the germ becomes stronger than the antibiotic.
Once the culture results are back, depending on the sensitivity, your doctor may prescribe the following:
- Ciprofloxacin
- Cephalexin or Ceftriaxone
- Faropenem
- Doxycycline and tetracyclines
- Injectable antibiotics such as tobramycin, amikacin and gentamicin
Can A Uti Go Away On Its Own
While most patients with a UTI will be prescribed antibiotics, the truth is, uncomplicated urinary tract infections are often self-limiting, meaning they can potentially run their course sans antibiotic treatment, noted a 2018 report in PLoS Medicine.
In fact, that same report found that more than one-half of the women studied experienced a UTI resolution without the use antibiotics. However, since kidney infections occurred in 7 out of 181 women using ibuprofen, the researchers concluded that, at this time, they cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs.
A better idea, for now: Simply wait until a positive urine culture comes back before treating with antibiotics.
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Trends In Intravenous Antibiotic Duration For Urinary Tract Infections In Young Infants
POTENTIAL CONFLICT OF INTEREST: Dr Lee has received institutional grant funding from Merck that is unrelated to the current study the other authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics
William W. Lewis-de los Angeles, Cary Thurm, Adam L. Hersh, Samir S. Shah, Michael J. Smith, Jeffrey S. Gerber, Sarah K. Parker, Jason G. Newland, Matthew P. Kronman, Brian R. Lee, Thomas V. Brogan, Joshua D. Courter, Alicen Spaulding, Sameer J. Patel Trends in Intravenous Antibiotic Duration for Urinary Tract Infections in Young Infants. Pediatrics December 2017 140 : e20171021. 10.1542/peds.2017-1021
To assess trends in the duration of intravenous antibiotics for urinary tract infections in infants 60 days old between 2005 and 2015 and determine if the duration of IV antibiotic treatment is associated with readmission.
Retrospective analysis of infants 60 days old diagnosed with a UTI who were admitted to a childrens hospital and received IV antibiotics. Infants were excluded if they had a previous surgery or comorbidities, bacteremia, or admission to the ICU. Data were analyzed from the Pediatric Health Information System database from 2005 through 2015. The primary outcome was readmission within 30 days for a UTI.
Is There Any Other Way To Prevent A Uti
While theres no foolproof way to ensure you never have a UTI, there are strategies and behaviors that may lower your risk:
- Stay hydrated.
- Women should wipe from front to back to stop the spread of bacteria.
- Avoid using douches, powders, sprays or other materials in the genital area.
Some physicians have begun recommending that patients add probiotics to their diet such as kefir, yogurt, various fermented foods, etc. as a form of prevention. No evidence indicates that probiotics can prevent a UTI on their own, but they do promote the growth of helpful bacteria in the vagina and bowels, which is beneficial for your overall health and may lower your risk of infection.
UTIs are commonplace so commonplace, in fact, that theyre one of the most frequently treated issues by telehealth professionals. If youre experiencing symptoms consistent with a UTI, dont wait until your schedule clears up to make an appointment with a physician. Dont wait for your doctors next in-office opening six weeks from now, either.
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How Common Are Utis
According to the National Kidney Foundation, 20% of women will experience a UTI at some point in their life. Of those, one in five will have a second UTI, and 30% of that narrowed group will have a third. Additionally, 80% of women who have three UTIs will have repeat infections after that.
Men also experience UTIs, but far less frequently. Contrary to popular belief, you do not have to be sexually active to get a UTI, although it does increase your likelihood as intercourse can facilitate the spread of bacteria.
Editorial Sources And Fact
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Iv Vs Po: Which Antibiotics Are Better For Common Ed Infections
January 21, 2020 by Anton Helman, MD, CCFP, FCFP
The perceived need for intravenous antibiotics drives many hospital admissions. In a sense, the decision to administer IV antibiotics instead of oral formulations represents a line in the sand between infections we are worried might kill a patient and ones that wont.
But for the vast majority of common infections we treat in the emergency department, oral antibiotics should actually be preferred over IV antibiotics when efficacy, safety, efficiency, and cost are taken into account together. My goal is to convince you to correctly choose oral antibiotics more often. I believe this will lead to fewer admissions, fewer hassles, and less suffering for our patients.
Of course, there are various physiological arguments that support oral antibiotics being theoretically as effective as IV antibiotics. But I know that, in order for us to change our behavior, the only thing that matters is whether data on outcomes support us. Here, I will concentrate on the clinically relevant outcome data for various indications and practical aspects comparing IV to oral antibiotics. Once armed with this knowledge, we should feel more comfortable prescribing pills and discharging rather than ordering IVs and admitting.
Who Else Has A Higher Risk Of A Uti
There are a handful of other factors that can boost your odds of developing a UTI. They include:
- Age
- Pregnancy
- Uncontrolled or inadequately controlled diabetes
- Certain forms of birth control, such as diaphragms that put pressure on the urethra
- Being sexually active, particularly with a new partner
- Anatomical abnormalities or blockages along the urinary tract, such as kidney stones
- Enlarged prostate
Because UTIs are so common, theyre also subject to a greater spread of misinformation than other conditions. Contrary to myth, you cannot get a UTI from using tampons or sanitary napkins, wearing tight clothing, riding a bike, or failing to urinate after intercourse.
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An Ounce Of Prevention
Unfortunately, most UTIs are not completely preventable, and are caused by differences in the structure or function of the urinary tract and immune system. But there are things you can do to keep healthy. For example, stay hydrated to increase urine production and flush out unwanted bacterial intruders. Good hygiene is also important, but scrubbing away at delicate genital tissues can damage them and create portals for bacteria. Clean your genital area gently with mild soap and water. Postmenopausal women may benefit from vaginal estrogen cream. Finally, eating cranberries and urinating after having sex havent been proven to have major benefits, but arent likely to hurt, either.
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About the Author
Lisa Bebell, MD, Contributor
Antibiotic Warnings And Treatment Concerns
The most commonly prescribed antibiotics for uncomplicated UTIs are similar in efficacy. But its important to note that ampicillin, amoxicillin, and sulfonamides are no longer the drugs of choice for combatting UTIs because of the emergence of antibiotic resistance. In addition, amoxicillin and clavulanate has been shown in previous research to be significantly less effective than others when it comes to treating urinary tract infections.
Also, as noted above, the FDA advises against using fluoroquinolones for uncomplicated UTIs. These medicines should only be considered if no other treatment options are available. In some cases, such as a complicated UTI or kidney infection, a healthcare provider may decide that a fluoroquinolone medicine is the best option, notes the American Academy of Family Physicians.
For pregnant women, some common antibiotics, such as fluoroquinolones and tetracyclines, should not be prescribed because of possible toxic effects on the fetus. But oral nitrofurantoin and cephalexin are considered good antibiotic choices for pregnant women with asymptomatic bacteriuria and acute cystitis, according to past research.
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Skin And Soft Tissue Infections
In multiple studies, no difference in clinical resolution of cellulitis has been demonstrated between IV and oral antibiotics for simple cellulitis.6-8 One study, a RCT, found no difference in convenience, complications, effectiveness, overall satisfaction, and mean time to cessation of advancement of cellulitis between oral and IV antibiotics.8 A Cochrane review of 25 studies including 2,588 patients comparing oral and IV antibiotics for uncomplicated cellulitis looking at symptoms rated by participant or medical practitioner or proportion symptom-free found that IV antibiotics were no better than oral ones. In fact, two of the studies suggested that oral antibiotics were more effective!9
This comports with the Infectious Diseases Society of America recommendation that IV antibiotics for nonpurulent cellulitis be reserved for patients who are immunocompromised or have systemic signs of infection, hemodynamic instability, or altered mental status.10 In fact, adherence to this guideline has recently been shown to reduce treatment failure rates in ED patients.11 In a recent retrospective chart review of 500 patients, independent predictors of oral antibiotic treatment failure for nonpurulent and soft tissue infections included tachypnea at triage, the presence of chronic ulcers, history of methicillin-resistant Staphylococcus aureus colonization or infection, previous recent cellulitis , chronic kidney disease, and diabetes.12
