Urinary Tract Infection - Medications

Doctors sometimes also prescribe other types of medications to help interstitial cystitis symptoms. These drugs include antihistamines such as hydroxyzine (Atarax), and low doses of the tricyclic antidepressant amitriptyline (Elavil). Drugs that reduce bladder spasms (hyoscine, oxybutynin) are also sometimes used. Some doctors think that interstitial cystitis may be related to immune disorders. Researchers are investigating various drugs that block immune and inflammatory responses.

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Treatments for Specific Populations

Treating the Pregnant Woman. Pregnant women should be screened for UTIs, since they are at high risk for UTIs and their complications. The antibiotics used during pregnancy are amoxicillin, ampicillin, nitrofurantoin, or an oral cephalosporin. Fosfomycin (Monurol) is not as effective as others but may be used during pregnancy. Resistance rates to this drug are also very low. They should not take fluoroquinolones.

Pregnant women with even asymptomatic bacteriuria (evidence of infection but no symptoms) have a 30% risk for acute pyelonephritis in their second or third trimester. Therefore they need screening and treatment for this condition. In such cases, they should be treated with a short course of antibiotics (three to five days). If this condition is recurrent, they can take low-dose nitrofurantoin. For an uncomplicated UTI, pregnant women may need longer-term antibiotics (seven to 10) for urinary tract infections.

Women with pyelonephritis have, to date, been hospitalized for treatment. One study suggested that outpatient treatment may be safe and effective if the condition develops in the early months of pregnancy. In the study, women were given an injection of ceftriaxone in the emergency room, observed for a few hours, and then administered a second injection. After this, they were sent home with a prescription for an oral antibiotic.

Treating Women with Diabetes. Women with diabetes have more frequent and more severe UTIs than women without the disease. Many experts recommend that patient with diabetes and UTI, even an uncomplicated infection, be treated with antibiotics for seven to 14 days. People with diabetes have higher than average rates of asymptomatic bacteriuria, but it is unclear whether they should be screened and treated for this condition. A 2003 study indicated that treating this condition had little value in these women and did not prevent complications.

Treating Urethritis in Men. Urethritis in men has typically been treated with a seven-day regimen of doxycycline. Some research is showing that a single dose of azithromycin may be just as effective while causing fewer side effects. One-dose treatment also improves compliance, so cure rates may even be better than with a long-term regimen. Of concern, however, is an infection that spreads to the prostate gland, which is harder to treat, so most doctors still prefer the longer regimen. It should be noted that azithromycin and similar antibiotics do not cure the infection and may mask the symptoms of an accompanying sexually transmitted disease, such as gonorrhea. Tests for such diseases should be conducted if urethritis is diagnosed.