Pho’s Urinary Tract Infection Program
An overview of our UTI program. We explain the rationale and evidence behind this program and how you can implement it in your home.
- Duration: 2 min
Detailed guide on UTI Program, which supports long-term care homes to improve the management and overuse of antibiotics of presumed UTIs in their residents.
Action To Take When You Get A Negative Test
If your test comes back negative, but you still have symptoms, the conclusion should be that further investigation is needed, NOT that the symptoms are not indicative of an infection.
|If a urine dipstick or lab test comes back negative but the patient is clearly describing symptoms of a UTI, doctors must listen to them. Urine tests are far from perfect and it is vital to interpret them in the context of the patients symptoms.|
If your UTI test is negative, it could very well be that the test is wrong.
First, it pays to understand why a test may be negative, despite your symptoms. Discussing this with your doctor will be more fruitful if you know what youre talking about.
So weve gone into this in great detail in our UTI testing section.
Second, you should be aware that medical practitioners rely on guidelines to guide their decisions. Unfortunately, most guidelines used by medical practitioners do not cover the inaccuracies of current UTI testing methods.
This means it is entirely possible your doctor has no knowledge of the issues with standard testing, and may not recommend investigating further. If youd like to share a reference with your doctor, one set of guidelines that does cover the issues with standard UTI testing is from the American Urogynecological Society.
Alternatively, you can look into private, independent testing or seek out a practitioner that specializes in chronic urinary tract conditions.
Are There Natural At
Yes. While taking antibiotics is still considered the gold standard of UTI treatments, there are some things you can do at home that help relieve symptoms, as well. These include:
- Drink plenty of water. Consuming at least six to eight 8-ounce glasses of water daily can help flush away UTI-causing bacteria, setting you up for a quicker recovery. Plus, the more you drink, the more youll have to urinate.
- Urinate often. Each time you empty your bladder, youre helping to flush bacteria out of your system.
- Try heat. Applying a heating pad to your pubic area for 15 minutes at a time can help soothe the pressure and pain caused by UTI-related inflammation and irritation.
- Tweak your wardrobe. Wearing loose cotton clothing and underwear can help you recover from a UTI.
- Go fragrance-free. Make sure your personal hygiene products are fragrance-free to sidestep further irritation, notes the National Institute of Diabetes and Digestive and Kidney Diseases.
- Cut out certain irritants. Caffeine, alcohol, spicy food, raw onions, citrus fruits, carbonated drinks, artificial sweeteners, and nicotine can further irritate your bladder, making it more difficult for your body to heal, per the Cleveland Clinic.
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The Problems With Frequent Antibiotic Use
Our own research has shown that many females with recurrent UTIs have taken the same antibiotic for years. For some this can mean every few weeks for others every few months.
|My doctor just calls in a prescription for the same antibiotic to whichever pharmacy I need them at, then I collect them. When Im overseas I stock up on cheap antibiotics if I can get them. Ive been taking the same antibiotic at least 15 years.|
The longer you suffer from recurrent UTIs, the muddier the waters of UTI treatment antibiotics can seem. After all, if the treatment options youve tried have failed to prevent further UTIs, are any of them really working?
For many people, taking UTI antibiotics frequently is concerning. Yet without having found an effective alternative, antibiotics are still their first port of call at the onset of a UTI.
On a basic level, frequent antibiotic use means organizing multiple prescriptions, planning ahead and spending money. But there is also serious concern around antibiotic-resistant superbugs, destroying your gut flora, and whether frequent antibiotic use even helps.
And as we mentioned in our section on what causes UTIs, there is enough evidence to suggest that ineffective antibiotic use could be a major contributor to the formation of chronic infection, embedded in the bladder wall.
Frequent antibiotic use that does not effectively treat chronic infection, can result in increased bacterial resistance, which again makes treatment more difficult.
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 .
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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.
Do You Need To See A Doctor To Get Antibiotics For A Uti
You need to speak with your doctor or a licensed medical professional to be prescribed antibiotics for a UTI. This can usually be done in person, at the doctor, or over the phone.
If this is your first UTI or your symptoms are severe, it may be helpful to get treated in person. You may also want to consider an in-person visit with your healthcare professional to rule out sexually transmitted infections if you are sexually active or have multiple sexual partners.
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Use Of Oral Antibiotics Reactions And Side Effects
Antibiotic use is widespread. As we know, used properly, antibiotics manage life-threatening infections, but as with any chemical compound sides effects can occur.
NHS England explain the most common reactions to antibiotics.
Always tell your specialist of previous reactions or allergies to medications during your consultations. Explain any other health issues that may be impacted by the use of antibiotics and if you are already prescribed antibiotics or other medications for separate health conditions.
Your specialist should explain possible side effects of your prescription during your appointment and your pharmacist can provide further information. Its always worth also reading the patient information leaflet provided with your medication.
Any medication has possible side effects. You should tell your specialist about any side effects and reactions immediately.
Clinicians recommend that if you are on a long term protocol, blood tests for liver function should take place every three to six months. You can usually arrange these through your GP or within clinic if this service is available. Your GP should notify you if there are result abnormalities and your specialist can advise on whether to decrease or stop antibiotics as a result.
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Can Doctors Treat Utis Via Telemedicine
Telemedicine is an increasingly popular method of treating UTIs. In addition to being convenient, its also discreet and frequently more affordable than an in-office visit.
Since doctors cant collect a urine specimen via telemedicine, they will typically make their diagnosis using a series of questions that identify and analyze your symptoms. Your telehealth provider will also want to know if you have a history of UTIs, as well as if there are any other factors that may complicate your UTI, such as pregnancy or a chronic health condition.
Ultimately, the fact that UTIs are extremely common assists physicians in their ability to accurately diagnose and treat UTIs online. In the event that your UTI symptoms present themselves as more severe or as something else entirely, your telemedicine professional will instruct you to visit another physician in the office for a follow-up or to perform a urinalysis. Most of the time, however, your telehealth provider can diagnose your infection and prescribe antibiotics via video alone. Certain telehealth providers may be able to fill your prescription as well, which can save you the expense of going through a pharmacy.
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Who Needs Antibiotics For Uti
While the question seems like it answers itself, treatment of UTIs is not always a straightforward affair. There are different bacteria involved, infections are discovered at different points in their pathology, and different people respond to antibiotics differently. So, while anyone suffering from a UTI will probably need to consider antibiotics, which one is the right one will vary from case to case and from person to person.
How the antibiotic is administered will also need to be determined on a case by case basis. As will the duration of treatment. These days, single-dose antibiotic treatment may also be a viable alternative.
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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Antimicrobial Susceptibility In Relation To Risk Factors
Overall susceptibility for commonly used antibiotics in upper UTI was low with 71.5% for Cip, 80.3% for Pip/taz, 84.6% for Gentamicin, 73.7% for Cefuroxime, 76.6% for Cefpodoxime and 85.4% for Ceftazidime . Ampicillin with Sulbactam had an overall susceptibility of 54.7% and was therefore not further analyzed. Only Imipenem showed an acceptable susceptibility rate of 96.4%.
Table 3 Susceptibility in % in relationship to number of risk factors
In order to recommend non-carbapenem antibiotics for the treatment of upper UTI in the ED we analyzed susceptibility rates by previously identified risk factors. Without a risk factor present all antibiotics had a susceptibility rate of around 90% and above . If one of seven risk factors were present, susceptibility for all antibiotics except for Imipenem dropped to around 80% . For 2 or more risk factors Cip, Cefuroxime and Cefpodoxime dropped to 60% and below, while Pip/taz, Gentamicin and Ceftazidime remained at around 75% . In this case, the susceptibility rate of Imipenem also dropped to 91.1% . Whereas cephalosporins and Gentamicin seem to be preferable in patients with no risk factors in regard to susceptibility, their susceptibility rates were similar to Pip/taz and Cip in patients with one risk factor. Interestingly, Pip/taz, Gentamicin and Ceftazidime kept their susceptibility rate relatively stable with more risk factors whereas Cip, Cefuroxime and Cefpodoxime dropped their susceptibility rates to a greater extent.
When Antibiotics Are Needed
Antibiotics may be used to treat bacterial infections that:
- are unlikely to clear up without antibiotics
- could infect others
- could take too long to clear without treatment
- carry a risk of more serious complications
People at a high risk of infection may also be given antibiotics as a precaution, known as antibiotic prophylaxis.
Read more about when antibiotics are used and why they are not routinely used to treat infections.
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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.
What Should We Do In The Light Of The Uncertainty
Based on the currently available evidence, prophylactic antibiotics remain the first line preventive treatment for uncomplicated recurrent UTI in women, and this is reflected in practice guidelines .
Nonetheless, increased awareness of antimicrobial resistance has led patients and clinicians to seek alternatives. It has been noted that non-antibiotic prophylactic agents seem generally well tolerated, with few adverse events or side effects reported in the preliminary work described. Some of the non-antibiotic treatmentsâfor example, vaginal oestrogens and probiotics, have been used extensively for other indications and therefore there are no concerns regarding their safety. As a result, there might be a case to support the use of non-antibiotic prophylactic agents, on an individual patient basis, for those who do not wish to take, or have an allergy or intolerance to, antibiotics.
Recommendations for future research
Population: Female patients with recurrent UTI
Intervention: Prophylactic treatments to reduce/prevent infection
Comparison: Prophylactic antibiotics
Outcome: Reduction in infection episodes, side effects of treatments, health economic analysis of cost effectiveness
Education into practice
When a patient presents with recurrent UTIs, ask yourself:
What to tell patients
How patients were involved in this article
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Editorial Sources And Fact
Box 1 Evidence For Nonantibiotic Agents In Preventing Recurrent Urinary Tract Infection In Premenopausal Women
Recent sexual intercourse within the past week and use of spermicide contraceptives have been shown to increase the risk of developing urinary tract infection in case-controlled and observational studies. Evidence for voiding habit, douching and wiping back to front have not been well studied and require further assessment.
Hydration and urinary concentration have been poorly studied as a way to reduce UTI recurrence. Evidence from survey-based studies has suggested that fluid restriction increases the risk of UTI, but further study of fluid intake and modification of urinary pH and osmolality is required. Evidence for the role of ascorbic acid in UTI prevention is lacking.
Chinese herbal medicine
Studies of Chinese herbal medicine are small with a high risk of bias. Further studies are required before this approach can be recommended for the prevention of recurrent UTI.
Cranberry products might be effective in reducing recurrent UTI in women with a history of recurrent UTI. A Cochrane review has reported no statistically significant benefit for cranberry products, but the level of heterogeneity among studies is high, and well-conducted, randomized, double-blind, placebo-controlled trials have reported positive results,, supported by a meta-analysis. Further well-powered randomized trials with strict inclusion criteria and consistent dosing are required.
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Side Effects Of Antibiotics
As with any medicine, antibiotics can cause side effects. Most antibiotics do not cause problems if they’re used properly and serious side effects are rare.
The common side effects include:
- being sick
- bloating and indigestion
Some people may have an allergic reaction to antibiotics, especially penicillin and a type called cephalosporins. In very rare cases, this can lead to a serious allergic reaction , which is a medical emergency.
Read more about the side effects of antibiotics.
Compliance With Ethical Standards
SWnone. KNpersonal fees from Adamed, Apogepha, Aristo, Bionorica, DaiichiSankyo, Enteris Biopharma, GlaxoSmithKline, Gruenenthal de Mexico, Helperby, Hermes, Leo-Pharma, Medice, MerLion, Meiji, MSD, OM Pharma, Paratek, Roche, Rosen Pharma, Saxonia, Zambon and non-financial support from Mission Pharmacal, outside the submitted work. TRconsultant for Astellas outside the submitted work. PMconsultant for Astellas, Bionorica, Ferring, outside the submitted work.
Consent statement is not applicable for this review manuscript.
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