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Treatment options for urinary tract infections | Understanding UTIs, Part 5

The fifth post in the Understanding UTI series outlines the different types of medications for UTIs, including antibiotics and drugs for pain relief.

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.

Types of antibiotics

Health care providers usually pick from one of three antibiotics for uncomplicated UTIs (UTIs in the lower urinary tract of non-pregnant, premenopausal women).

  • Nitrofurantoin (brand name Macrobid): This drug is used in 32% of UTIs in the United States.
  • Trimethoprim-sulfamethoxazole (Bactrim): This combination of two drugs is used in 26% of UTIs in the United States.
  • Fosfomycin (Monurol): This newer drug only has to be taken one time, but it's expensive and rarely prescribed.

There are benefits and risks to each drug. While they all provide relief and help cure the infection, potential side effects include diarrhea, nausea and headaches.

If you have allergies to any antibiotics, such as sulfonamide "sulfa" drugs, your treatment might be different. Sulfa allergies are often accompanied by a skin rash or fever, so let your doctor know if this occurs as a result of your treatment.

If you are given antibiotics, be sure to follow the instructions and finish the full course of medication given to you. This helps prevent reinfection.

Antibiotics that shouldn't be a first choice for uncomplicated UTIs

Other antibiotics appear to be overused, and some physicians may misuse non-recommended antibiotics as first-line treatments. Ciprofloxacin (Cipro) is used in 35% of uncomplicated UTIs, while levofloxacin is used in 2%. These antibiotics can be important treatments in some cases of more complicated UTIs, but can have dangerous side effects.

The U.S. Food and Drug Administration warns that the use of these drugs should be restricted because of their potentially disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. Additionally, in many parts of the country, bacteria commonly causing UTIs are becoming resistant to these antibiotics.

New therapies are emerging

In addition to antibiotics, there are some emerging treatment options, including d-mannose, a sugar that can be taken orally to stop the proliferation of bacteria in the bladder. This is a newer drug and has not yet been incorporated into routine clinical practice.

Managing pain

If you are prescribed antibiotics, the drugs should provide relief within two to three days. Symptoms such as dysuria, or painful urination, can often be relieved in just a few hours.

However, UTIs often cause discomfort, in which case there are options for pain management. Phenazopyridine (brand name Pyridium or AZO) can be prescribed or obtained as an over-the-counter option to give immediate relief. This drug does cause urine and other secretions, such as tears, to turn bright orange, which can sometimes stain contact lenses. While effective as pain reliever, this drug does not treat UTIs.

What if I don't go to the doctor?

What happens when UTIs are left untreated? Contrary to popular belief, your immune system is often able to clear a UTI on its own. Studies have found that 25-42% of women are able to recover from an uncomplicated UTI without antibiotics.

But that means a majority of UTIs do not go away on their own. If left untreated, they can lead to continued discomfort and other more serious health issues, such as kidney damage or a severe infection. Therefore, treatment is recommended.

"Physicians tailor care plans to each patient, and there is no sole treatment for everyone," says Stanford physician Kim Chiang, MD. During your visit, feel free to ask in-depth questions, particularly if a non-recommended antibiotic is prescribed.

This is the fifth post in the series Understanding UTIs. The goal of this seven-part series is to provide easy-to-understand, scientifically grounded information about UTIs. Patients referenced are composites, compiled from actual patient experiences. Data on medications used for UTIs were extracted from the National Disease and Therapeutic Index, a nationally representative physician survey produced by IQVIA.

Joanna Langner is a graduate student in Community Health and Prevention Research at Stanford who is interested in health disparities and women's health. She wrote this series with the support of Randall Stafford, MD, PhD, professor of medicine and director of the Program on Prevention Outcomes and Practices, and Kim Chiang, MD, clinical assistant professor of medicine.

Photo by Christina Victoria Craft

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