Urinary Tract Infection - Medications

Treatment for Uncomplicated UTIs

Studies are now reporting that uncomplicated UTIs in low-risk women can often be successfully treated over the phone. In such cases, a health professional, usually a nurse, provides the patients with three-day antibiotic regimens without even requiring an office urine test. This course is now recommended only for women at low risk for recurrent infection and who do not have symptoms suggesting other problems, such as vaginitis. In some centers, women who are treated over the phone have to be less than 55 years old; all other patients need to see a doctor for evaluation.

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Antibiotic Regimen. Oral antibiotic treatment cures 94% of uncomplicated urinary tract infections, although the rate of recurrence remains high. The following are antibiotics used for uncomplicated UTIs.

The standard regimen is a three-day course of trimethoprim-sulfamethoxazole, commonly called TMP-SMX (Bactrim, Cotrim, Septra). A single oral dose of TMP-SMX is sometimes prescribed in mild cases, but cure rates are generally lower (87%) than with the three-day regimens. (Longer-term therapy, given for seven to 10 days, is now mostly limited to men, children, the elderly, people with diabetes with any UTI, and women with pyelonephritis or who are pregnant.)
An antibiotic called a fluoroquinolone, such as ciprofloxacin (Cipro), is usually the second choice. In fact, it is often the first choice where there are the high rates of bacterial resistant to TMP-SMX. Fluoroquinolones can also be given in a three-day course. Pregnant women should not take these drugs.
Nitrofurantoin (Furadantin, Macrodantin) is a third option. Thisdrug must be given for longer than three days.
Fosfomycin (Monurol) is not as effective as other antibioticsbut may be used during pregnancy. Resistance rates to this drug are also very low.

After a week of antibiotic treatment, most patients are free of infection. If the symptoms do not clear up within the first few days of therapy, doctors generally suggest that women discontinue their antibiotic and provide a urine sample for culturing in order to identify the specific organism causing the condition.

Treatment for Relapsing Infection. A relapsing infection (caused by treatment failure) occurs within three weeks in about 10% of women. Relapse is treated similarly to a first infection but the antibiotics are continued for at least two weeks. (Relapsing infections may be due to structural abnormalities, abscesses, or other problems that may require surgery, and such conditions should be ruled out.)