Urinary Tract Infection - Medications

Antibiotic Treatment for Recurrent Infections

Preventive antibiotics may be required for women who experience two or more symptomatic UTIs within six months or three or more over the course of a year. There are various approaches that are available. A woman's own perception of discomfort can generally guide her decisions on whether to use preventive antibiotics or not. All women should use life-style measures to prevent recurrences.

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Intermittent Self Treatment. Many, if not most, women with recurrent UTIs can effectively self treat recurrent UTIs without going to a doctor. In general, she takes the following steps:

As soon as the patient develops symptoms, she takes the antibiotic. Infections that occur less than twice a year are usually treated as if they were an initial attack, with single-dose or three-day antibiotic regimens.
At that time, she also performs a clean-catch urine test and sends it to the doctor for culturing to confirm the infection.

A doctor should be consulted under the following circumstances:

If symptoms have not completely resolved within 48 hours.
If there is a change in symptoms.
If the patient suspects that she is pregnant.
If the patient has more than four infections a year.

Women who are not good candidates for self-treatment are those who are unable to diagnose themselves or women with impaired immune systems, previous kidney infections, structural abnormalities of the urinary tract, or a history of infection with antibiotic-resistant bacteria.

Postcoital Antibiotics. If recurrent infections are clearly related to sexual activity and episodes recur more than two times within a six-month period, a single preventive dose taken immediately after intercourse has proven to be very effective. Antibiotics in such cases include TMP-SMX, nitrofurantoin, cephalexin, or a fluoroquinolone (such as ciprofloxacin). (Fluoroquinolones are not appropriate during pregnancy.)

Continuous Preventive Antibiotics (Prophylaxis). Continuous preventive (prophylactic) antibiotics are an option for some women who do not respond to other measures. With this approach, low-dose antibiotics are taken continuously for six months or longer.

Typical prophylactic regimens include one dose of nitrofurantoin (50 mg), 1/2 tablet of TMP-SMX, or cephalexin (250 mg) daily. Taking the antibiotic at bedtime may be most effective. Studies suggest that continuous prophylactic antibiotics reduces recurrences by up to 95% and may prevent kidney infection.

Adverse effects mostly include gastrointestinal problems and yeast infections. (Taking probiotic supplements or eating yogurt may help prevent yeast infections.) Although there is concern that continuous risk increases the risk for bacteria that are resistant to the antibiotics, studies to date have not reported any significant risk even up to five years of use.