Are You Receiving the Right UTI Treatment?
A new study reveals that most women aren’t getting the optimal antibiotic prescription.
Urinary tract infections (UTIs) are seriously the pits. They can be uncomfortable and even a tad embarrassing to talk about, but they’re extremely common: More than half of all women get at least one UTI in their lifetime. Of those diagnoses, 25% are classified as recurring UTIs, meaning the infection comes back two or three times in less than a year. Age, biological sex, and genetics all play a role in UTI risk, along with lifestyle factors like sexual activity and personal hygiene. And there are some people that just get UTIs more often than others, no matter how hard they work to prevent them.
The standard treatment for UTIs is a course of antibiotics prescribed by your doctor. But did you know there are multiple antibiotic options to treat UTIs, and not all of them are created equal? A 2021 report in Infection Control & Hospital Epidemiology found that most U.S. women receive inappropriate treatment for their UTI(s), meaning they either get the wrong antibiotic or take the antibiotic longer than necessary. This can have profound consequences not only for the patient, who wants her UTI cleared ASAP, but for the entire field of medicine (more on that later).
UTI Treatments: Right vs. Wrong
This study looked at private insurance claims from women in the United States to see what treatment they received for their UTIs. “Of the 670,450 patients in our study, nearly half received [the wrong antibiotic] and almost three-quarters received prescriptions with inappropriately long treatment durations,” says Ann Mobley Butler, Ph.D., study author and epidemiologist at Washington University School of Medicine in St. Louis. Women living in rural areas were more likely than urban women to receive the wrong treatment.
It’s not that health care providers were deliberately prescribing the wrong antibiotics; more likely, researchers believe, is that they weren’t aware of the changing guidance regarding appropriate treatment for bacterial infections. In other words, your doctor isn’t trying to be unhelpful, but they may not realize antibiotics aren’t prescribed the same way now that they were years ago. Particularly in rural areas, there seems to be a gap in clinicians’ knowledge of changing practices.
What does this mean for you? If your doctor prescribes an antibiotic that is too broad (meaning it targets a wide variety of bacteria), it might not work against the specific type of bacteria that caused your UTI. This could cause your symptoms to last longer than necessary and result in the need for a second antibiotic prescription to clear up the infection. “The optimal treatment [for a UTI] is the narrowest spectrum antibiotic for the shortest accepted duration,” explains Priya Nori, M.D., director of antimicrobial stewardship at Montefiore Health System in New York City. Ideally, your prescription should last three to five days but no longer.
One more reason to shorten your antibiotic regimen: These drugs can cause digestive issues because of the impact they have on your gut bacteria. So, the longer you’re stuck taking an antibiotic, the more likely you’ll have to deal with a stomachache while the drugs are in your system.
The Danger of Antibiotic Resistance
There’s a bigger reason why antibiotic misuse can be problematic—it contributes to something called antibiotic resistance. This is what happens when bacteria adapt to the drugs we use to kill them, making them harder and harder for modern medicine to treat.
Bacteria are living creatures, and they’re pretty tough for their small size. Over time, they “catch on” to the drugs used against them and develop resistance mechanisms to survive. The more people consume a particular antibiotic, the smarter bacteria get against it. Antibiotic-resistant bacteria are much harder to treat because, as you can imagine, we don’t have drugs that work against them.
At least 2.8 million people are infected with antibiotic-resistant bacteria every year in the U.S. In serious cases, it can result in death—the CDC estimates that 35,000 people die annually from this crisis. It’s impossible to prevent antibiotic resistance entirely (bacteria are always going to mutate), but the more people overuse antibiotics, the more susceptible the entire society becomes to contracting dangerous antibiotic-resistant bacteria. This is especially worrisome for people with compromised immune systems because their bodies aren’t as prepared to fight off a bacterial infection.
How to Get the Right UTI Prescription
It’s ultimately your doctor’s responsibility to stay informed on best practices regarding antibiotic use. But still, the more you know about this problem, the better prepared you can be when you go in for treatment. Dr. Nori recommends people ask their doctor the following questions:
Are antibiotics required to treat my condition?
Do I have a true UTI or a different (but related) bacterial infection?
What is the shortest and most targeted regimen of antibiotics you can prescribe me?
What can I do to prevent UTIs in the future?
Speaking of UTI prevention, it’s the best way to keep yourself from ending up in this situation again. Even if you have a genetic predisposition to recurring UTIs, there are things you can do to minimize your risk: always pee after sex (including masturbation), clean your sex toys after each use, wipe front to back, and change out of wet or sweaty clothing as soon as possible.
UTI Vaccine: The Future of Treatment?
One day in the not-too-distant future, we might have an entirely new way of preventing UTIs… a vaccine. New research in the Proceedings of the National Academy of Sciences describes a vaccine candidate that, when directly introduced into the bladder using a catheter, could boost your immune response against future UTI infection.
“We’re able to essentially induce immunity that will sterilize and remove all the [UTI-causing] bacteria from the bladder,” says Soman Abraham, Ph.D., study author and professor of pathology at Duke School of Medicine in Durham, NC. “You not only get protected against future infections, but you also eradicate any residual bacteria.” This vaccine would be targeted toward people who get recurring UTIs. “If you have one infection in three years, I wouldn’t recommend it,” Abraham says. “It would only be people with two to three infections every year.”
So far, this vaccine candidate has only been tested in mice, so the next step is human clinical trials. But Abraham feels optimistic that it could be available to the public in the next several years. “If the results come out the way we would like and suspect, it shouldn’t take too long,” he predicts. Until then, antibiotics are the way to go—so let’s all do our best to make sure we’re using them correctly.
- UTI Antibiotic Study: Infection Control & Hospital Epidemiology. (2021.) “Rural–urban differences in antibiotic prescribing for uncomplicated urinary tract infection.” cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/ruralurban-differences-in-antibiotic-prescribing-for-uncomplicated-urinary-tract-infection/E2927104A8CB31226B8E31339A697C7C
- UTI Prevalence: Sultan Quaboos University Medical Journal. (2013.) “Recurrent Urinary Tract Infections Management in Women.” ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
- Broad vs. Narrow Spectrum Antibiotics: Patient-Centered Outcomes Research Institute. (2018.) “Comparing Broad- and Narrow-Spectrum Antibiotics for Children with Ear, Sinus, and Throat Infections.” pcori.org/research-results/2013/comparing-broad-and-narrow-spectrum-antibiotics-children-ear-sinus-and-throat
- Antibiotic Resistance (1.): World Health Organization. (2020.) “Antibiotic resistance.” who.int/news-room/fact-sheets/detail/antibiotic-resistance
- Antibiotic Resistance (2.): Centers for Disease Control and Prevention. (n.d.) “How Antibiotic Resistance Happens.” cdc.gov/drugresistance/about/how-resistance-happens.html
- UTI Vaccine Candidate: Proceedings of the National Academy of Sciences of the United States of America. (2021.) “Local induction of bladder Th1 responses to combat urinary tract infections.” pnas.org/content/118/10/e2026461118