Urinary Tract Infection - Treatment

Symptomatic bacterial infections are treated with antibiotics. If the infection is treated promptly, a three-day course of antibiotics is as effective as a seven to ten-day course of medication. Furthermore, a shorter course of therapy costs less and causes fewer side effects such a diarrhea or vaginal yeast infection compared to a longer course of treatment. Options for treating uncomplicated urinary tract infections include one or more of the following:

Self-directed therapy:

According to scientific studies, women can accurately diagnose a UTI based on symptoms alone. Researchers reported that 84% of urine cultures showed an infection and 11% of specimens showed pus cells or bacteria when women experienced UTI symptoms.4

If women can identify when they have a UTI and the infection responds to a three-day course of antibiotics, then self-directed therapy is a viable option for treating subsequent infections. The routine is as follows: At the first onset of UTI symptoms, women take an antibiotic and continue therapy for three days. The choice of antibiotics varies, but may be either Macrodantin 50 mg four times daily, Macrobid 100 mg twice daily, Septra DS one tablet twice daily, or a fluoroquinolone such as Cipro 500mg (one half or one pill) twice daily, Cipro XR 1000mg once daily, or Levaquin 500mg (one half or one pill) once daily. Yearly office visits are required before another twelve-month prescription for antibiotics will be written.

If symptoms persist despite antibiotic therapy, it may be caused by a ‘break through’ infection. Three quarters of subsequent infections are caused by a different strain of bacteria. Although most of these bacteria will respond to the chosen antibiotic, bacteria can develop resistance, especially if antibiotics are used frequently. If an antibiotic other than a fluoroquinolone has been routinely used for self-directed therapy, additional treatment with a three-day course of a fluorquinolone will usually eradicate the break through infection. If symptoms persist though, or frequent break through infections occur, a repeat office visit is recommended. In this situation, antibiotics should be stopped for at least 24 hours before coming in for visit to allow sufficient time for antibiotics to be cleared from the system, especially if once-a-day antibiotics have been used, since residual antibiotics will interfere with the urine culture results. A mid stream or catheterized urine culture will help sort out whether lingering symptoms are due to inflammation versus a resistant bacterial organism.

Antibiotic after sex:

If UTIs occur after sexual intercourse, taking a single antibiotic after sex can prevent recurrent urinary tract infections.5 Alternatively, self-directed therapy may require fewer antibiotics in the long run, depending upon the level of sexual activity and number of yearly infections.

Continuous antibiotic suppression:

If infections occur more than 4 times yearly, taking one quarter of the normal dose of antibiotics either nightly or every other day can prevent infections by 95% as long as the antibiotics are continued.6 However, once the antibiotics are stopped, UTIs will usually reoccur.

When not to treat a UTI:

Approximately 3.5% of the general population has bacteria in their urine without symptoms. The incidence of asymptomatic bacteriuria increases with age and affects 15- 20% of women aged 65-70 and 20-50% for women older than 80 years. Furthermore, it’s not unusual for female children and patients with diabetes or spinal cord injuries to have asymptomatic bacteriuria. Antibiotic treatment is not only unnecessary in this situation, it can actually make matters worse. Treating asymptomatic bacteriuria with antibiotics increases the risk of developing a serious kidney infection.7

Prevention:

Scientific research has shown that the use of spermicides adversely affects the vaginal ecosystem and increases the risk of recurrent UTIs. Consumption of eight ounces of unsweetened cranberry juice daily or taking a cranberry extract pill three times daily can also decrease the incidence of recurrent UTIs.

Unproven, but common sense measures that may decrease the incidence of recurrent UTIs include drinking at least 64 ounces of water daily, wiping after urination from front to back, urinating after sexual intercourse, and avoiding chemical douches.

Urinary irritants such as caffeine and consumption of hot and spicy foods won’t cause a UTI but they can provoke symptoms that mimic ‘cystitis’. Keeping a diary of food and beverage consumption during symptomatic episodes can help identify triggers. Stress is another common cause of bladder symptoms. Stress activates the adrenal glands to release adrenaline – the ‘fight-or-flight’ hormone- that in turn stimulates the nerves that cause the bladder to become overactive.

Taking a probiotic such as acidophilus twice daily with food whenever antibiotics are taken and for several weeks thereafter can help prevent antibiotic-related side effects such as abdominal bloating, diarrhea, and vaginal yeast infection. Probiotics should be refrigerated after the bottle is opened.

Click here to download a PDF with information about Probiotics.

Click here to download a PDF on Female Recurrent Urinary Tract Infections.

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Resources:

1 Nickel, JC. Practical Management of Recurrent Urinary Tract Infections in Premenopausal Women. Reviews in Urology. 2005; 7 (1): 11-17

2 Krieger, JN. Urinary Tract Infections: What’s New? J Urol. 2002; 168: 2351-2358

3 Krieger, JN. Urinary Tract Infections: What’s New? J Urol. 2002; 168: 2351-2358

4 Gupta, K, et al. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med. 2001; 135: 9-16

5 Stapleton, AEet al. Postcoital antimicrobial prophylaxsis for recurrent urinary tract infections : A randomized, double-blind, placebo-controlled trial. JAMA. 1990; 264: 703-706

6 Krieger, JN. Urinary Tract Infections: What’s New? J Urol. 2002; 168: 2351-2358

7 Krieger, JN. Urinary Tract Infections: What’s New? J Urol. 2002; 168: 2351-2358

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