Tuesday, September 27, 2022

What Antibiotics Are Best For Urinary Tract Infections

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Can A Urinary Tract Infection Be Prevented

Mayo Clinic Minute: Treating Urinary Tract Infections

Many methods have been suggested to reduce or prevent UTIs. The single most important prevention measure is increased fluid intake. Many people develop UTIs simply because they do not drink enough fluids. Some of these are considered home remedies and have been discussed . There are other suggestions that may help prevent UTIs. Good hygiene for males and females is useful. For females, wiping from front to back helps keep pathogens that may reside or pass through the anal opening away from the urethra. For males, retracting the foreskin before urinating reduces the chance of urine lingering at the urethral opening and acting as a culture media for pathogens. Incomplete bladder emptying and resisting the normal urge to urinate can allow pathogens to survive and replicate easier in a non-flowing system. Some clinicians recommend washing before and urinating soon after sex to reduce the chance of urethritis and cystitis. Many clinicians suggest that anything that causes a person irritation in the genital area may encourage UTI development. Wearing underwear that is somewhat adsorptive may help wick away urine drops that otherwise may be areas for pathogen growth.

Why Antibiotics Are The Golden Standard

Urinary tract infections occur due to an external bacterial infection in the urinary tract of a body. The most common treatment option is a course of antibiotic therapy that targets the pathogens and the bacteria causing the infection.

The appropriate antibiotic course leads to higher symptomatic and bacteriological cure rates and significantly reduces the chances of reinfection. The types of antibiotics prescribed as the first line of treatment are based upon the type of bacteria found in your urine after the urine analysis, your health status, and the severity of the infection.

Drink Plenty Of Liquids

Drinking plenty of liquids, particularly water, will help to wash bacteria from your bladder and urinary tract.

Drinking cranberry juice or taking cranberry extracts may also help prevent urinary tract infections . However, you should avoid cranberry juice or extracts if youre taking warfarin, a medicine used to prevent blood clots. Cranberry juice can make the effects of warfarin more potent, so theres a risk of excessive bleeding.

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How Does Nitrofurantoin Work Uti & Pregnancy

Nitrofurantoin helps kill the bacteria that cause urinary tract infections. It only works against certain types of bacteria, meaning that some bugs are sensitive to the antibiotic while others are resistant.

You cannot know if a bacteria strain is sensitive to an antibiotic unless you test it in the urine.

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Can I Go To Work With A Kidney Infection

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

Most kidney infections are treated on an outpatient basis with oral antibiotics. Symptom relief typically occurs after a few days of treatment, so it may be possible to go to work at that point. Many patients, however, require a week or two before they feel well enough to work. As always, never go to work with a fever.

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First Line Antibiotics For A Uti

  • Ampicillin
  • Nitrofurantoin
  • Trimethoprim/sulfamethoxazole

Notably absent from the list of antibiotics prescribed for the treatment of UTIs is Amoxicillin. While very popular and useful in treating numerous other bacterial infections, urinary tract infections are not amongst the infections Amoxicillin is used for.

Are There Any Over

Over-the-counter antibiotics for a UTI are not available. You should see your doctor to have your symptoms evaluated.

Your provider may recommend an OTC product called Uristat to numb your bladder and urethra to ease the burning pain during urination. Uristat can be bought without a prescription at the pharmacy. A similar phenazopyridine product called Pyridium is also available.

Take phenazopyridine for only 48 hours, and be aware it may cause your urine to turn a brown, orange or red color which may stain fabrics or contact lenses. It may be best to not wear contact lenses while being treated with phenazopyridine.

Phenazopyridine is not an antibiotic and will not cure a UTI.

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What About Antibiotic Resistance

Resistance rates for antibiotics are always variable based on local patterns in the community and specific risk factors for patients, such as recent antibiotic use, hospital stay or travel. If you have taken an antibiotic in the last 3 months or traveled internationally, be sure to tell your doctor.

High rates of antibiotic resistance are being seen with both ampicillin and amoxicillin for cystitis , although amoxicillin/clavulanate may still be an option. Other oral treatments with reported increasing rates of resistance include sulfamethoxazole and trimethoprim and the fluoroquinolones. Resistance rates for the oral cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.

Always finish taking your entire course of antibiotic unless your doctor tells you to stop. Keep taking your antibiotic even if you feel better and you think you don’t need your antibiotic anymore.

If you stop your treatment early, your infection may return quickly and you can develop resistance to the antibiotic you were using previously. Your antibiotic may not work as well the next time you use it.

Can Kidney Infection Be Prevented

Ask Dr. Nandi: Antibiotic-resistant urinary tract infections are on the rise

Hygiene: The main approach to the prevention of kidney infection is proper hygiene. Because the majority of infections tend to happen due to the presence of bacteria entering the urinary tract from the urethra, proper personal hygiene plays theoretical importance in preventing urinary infections. For example, in women, wiping the genital area from front to back after going to the bathroom may significantly prevent bacteria around the anus or vagina to gain access to the urethra. Hygienic use of bathtubs and douching may also have a preventive role, but is not universally supported by clinical experts.

Sex: Because sexual intercourse is another risk factor for kidney infection, it is advised to empty the bladder after sexual activity to drain bacteria that may have entered the bladder. This practice, however, is not overwhelmingly proven by available clinical data and not recommended by some experts.

Antibiotics: Preventive antibiotic therapy can sometimes be helpful in women who have recurrent UTIs . This could be guided by the presence of symptoms suggestive of an infection or after sexual intercourse if infections are temporally associated with sexual intercourse. Preventive antibiotics are also recommended for patients undergoing invasive urologic procedures when bacteria are detected in screening urine culture.

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What Other Information Should I Know

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your bodys response to meropenem and vaborbactam injection.

It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Population Health Research Capsule

What do we already know about this issue?

Previous studies have found overuse of antibiotics for urinary tract infections .

What was the research question?

To evaluate the appropriateness of antibiotic prescriptions for UTIs.

What was the major finding of the study?

Antibiotics were overused and inappropriate antibiotics were commonly prescribed for suspected UTIs.

How does this improve population health?

This study identified antibiotic misuse including overly broad antibiotics and overdiagnosis of UTIs, which can promote antimicrobial resistance.

Patients were categorized as having uncomplicated cystitis or pyelonephritis based on their ICD-10 code. In cases where the ICD-10 code CM N39.0 for urinary tract infection, site not specified was used, the authors categorized patients as having either cystitis or pyelonephritis based on medical chart documentation of symptoms, vital signs, physical exam, and provider impression. Patients were assigned to the pyelonephritis cohort if they had fever, flank pain, or costovertebral angle tenderness.

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Complicated & Recurrent Uti

Antibiotics should never be selected empirically for complicated UTI without culture susceptibility results . Management of pyelonephritis, prostatitis, and relapsing or recurrent UTI is often unsuccessful without therapy guided by culture and susceptibility results. However, therapy should be instituted while culture and susceptibility results are being awaited. Rational initial drug choices for complicated UTI include amoxicillin, fluoroquinolones, or trimethoprim-sulfonamide.3

Antibiotics That Shouldn’t Be A First Choice For Uncomplicated Utis

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

Other antibiotics appear to be overused, and some physicians may misuse non-recommended antibiotics as first-line treatments. Ciprofloxacin 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.

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Pregnancy And Breast Feeding

Its use during pregnancy is contraindicated, although it has been placed in Australian pregnancy category C. Its use during the first trimester and 12 weeks prior to pregnancy has been associated with an increased risk of congenital malformations, especially malformations associated with maternal folic acid deficiency such as neural tube defects such as spina bifida, cardiovascular malformations , urinary tract defects, oral clefts, and club foot in epidemiological studies. Its use later on during pregnancy also increases the risk of preterm labour and low birth weight . Animal studies have yielded similarly discouraging results.

It appears to be safe for use during breastfeeding as long as the baby is healthy.

Recurrent Urinary Tract Infections

Patients with three or more infections per year should be offered either continuous low-dose antibiotic prophylaxis, patient-initiated, or postcoital prophylaxis if the onset of infection is linked to sexual intercourse .7 Before a prophylactic regimen is chosen, a urine culture should be performed to determine the susceptibility of the pathogen. The duration of continuous prophylactic therapy is usually 6 months to a year. Unfortunately, within 6 months of discontinuing antibiotic prophylaxis, 40% to 60% of women develop a urinary tract infection, and prophylaxis must be resumed.20 Patient-initiated therapy at the onset of symptoms has been shown to be effective in young, healthy nonpregnant women.21 Short-course regimens have been advocated for patient-initiated therapy in compliant women with frequently recurring and symptomatic urinary tract infections. The major advantages of short-course therapy over continuous therapy are convenience and the avoidance of antibiotic toxicity symptomatic infections are not prevented, however. For postcoital prophylaxis, nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones taken within 2 hours after sexual intercourse have been shown to significantly reduce the incidence of recurrent cystitis.22, 23

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How To Feel Better

If your healthcare professional prescribes you antibiotics:

  • Take antibiotics exactly as your healthcare professional tells you.
  • Do not share your antibiotics with others.
  • Do not save antibiotics for later. Talk to your healthcare professional about safely discarding leftover antibiotics.

Drink plenty of water or other fluids. Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. Talk with your healthcare professional if you have any questions about your antibiotics.

Is It Possible To Prevent Urinary Tract Infections With Diet And Supplements

UTI l Urinary Tract Infection & Pyelonephritis Treatment for NCLEX RN & LPN

It is possible to reduce the chance that a UTI will develop with dietary methods and some supplements but prevention of all UTIs is unlikely with these methods. Supplements such as eating cranberries, taking vitamin C tablets, and eating yogurt and other substances also may reduce the chance that a UTI will develop . However, as stated in the prevention section, changes in a person’s lifestyle may reduce the chance getting a UTI as good as, if not better than, any diet or supplement.

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What Are The Symptoms Of A Uti

Symptoms of a UTI can differ depending on what part of the urinary tract is infected.

A bladder infection usually causes symptoms that include the following:

  • Burning when urinating
  • The feeling that you need to pee frequently, but when you go to the toilet very little urine comes out
  • Pain in the pelvic area just above the pubic bone.

Bladder infections are usually considered a simple UTI and treatment is usually with antibiotics for three to five days. Symptoms usually resolve in a couple of days.

People with an infection of the urethra may experience symptoms similar to a bladder infection in addition to itching or irritation at the end of the urethra where the pee comes out.

Symptoms of a kidney infection are usually more widespread and more severe than those of a bladder infection and may include:

  • Fever or chills
  • Pink or red-tinged urine
  • Burning when urinating
  • The feeling that you need to pee frequently, but when you go to the toilet very little urine comes out
  • Pain in the pelvic area just above the pubic bone
  • Moderate to severe lower back pain
  • Nausea or vomiting.

Common Side Effects With Antibiotic Use

Each antibiotic is responsible for its own unique list of side effects, and the list is usually extensive. Be sure to discuss your individual antibiotic side effects with your healthcare provider. However, there are side effects that are common to most antibiotics, regardless of class or drug:

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Uncomplicated Urinary Tract Infections

Uncomplicated UTIs are due to a bacterial infection, most often caused by E coli. UTIs affect women much more often than men.

Cystitis

Cystitis, or bladder infection, is the most common UTI. It occurs in the lower urinary tract and is much more common in women. In most cases, the infection is brief and acute and only the inner surface of the bladder is infected. Deeper layers of the bladder may be harmed if the infection becomes persistent, or chronic, or if the urinary tract is structurally abnormal.

Pyelonephritis

Sometimes, the infection spreads to the upper urinary tract . This is called pyelonephritis, or more commonly, a kidney infection.

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What Are Uti Symptoms

ASK DIS: Urinary Tract Infection: Antibiotics in Adults

Symptoms of UTIs may include the following: pain or burning when urinating, pressure in the low belly, an urge to urinate often, and fatigue and shakiness. If you have severe pain in your back or lower abdomen, vomiting, nausea, or fever, see your healthcare provider immediately. These can be signs of a serious kidney infection. Speak with your healthcare provider if you think you may have a UTI.

  • Urinary Tract Infection, Centers for Disease Control and Prevention . Web. 20 September 2021.
  • Bladder Infection in Adults, National Institute of Health . Web. 20 September 2021.
  • Urinary Tract Infections, MedlinePlus. Web. 20 September 2021.
  • Urinary Tract Infections, Mayo Clinic. Web. 20 September 2021.
  • Phenazopyridine, MedlinePlus. Web. 21 September 2021.

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What Is The First

First-line antibiotics for acute, uncomplicated urinary tract infections typically include:

  • Fosfomycin
100 mg twice daily for 7 days $71

Since there is a lower chance of antibiotic resistance with nitrofurantoin and fosfomycin as compared to other classes of antibiotics, they are often used as first-line antibiotics for the treatment of UTI.

However, for severe UTI with complications, fosfomycin or nitrofurantoin may not be effective.

Monitoring Response To Therapy

Patients with a simple, uncomplicated UTI may not require rigorous monitoring. However, patients with complicated, relapsing, or recurrent infections should be monitored very closely. The following protocol is recommended to monitor response to therapy in patients with relapsing, recurrent, or refractory UTI.3

  • Recheck urine culture 5 to 7 days into antibiotic therapy. This confirms that the prescribed dose and frequency of the drug were successful in treating the organism isolated. This culture also may reveal an additional isolate that could not be identified in the initial culture. Any bacterial growth observed at this time suggests treatment failure. Reconsider the choice of antibiotic, dose, and administration frequency.
  • Recheck urine culture 3 days before discontinuing antibiotic therapy. This is an optional step, but it confirms that, when therapy was discontinued, the patient still had a negative culture. Positive bacterial growth at this stage suggests a refractory infection or newly inoculated organism. Investigate patients for any nidus of infection . Alter treatment and institute new therapy for the same duration as previously intended.
  • Recheck urine culture 7 days after discontinuing antibiotic therapy. Positive growth should prompt investigation for causes of relapse or reinfection.
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    Implications For Research And Practice

    Based on the data we analysed, a pragmatic approach is required when considering prescribing long-term antibiotics in older patients with recurrent UTI. Although long-term antibiotics may reduce the risk of UTI recurrence in women, this benefit diminishes on cessation of treatment. Little is known about optimal prophylaxis period, long-term effects on health, risk of antibiotic resistant infections, effect in older men, effect in frail care home residents or impact on important patient-centred outcomes. These unknowns must be balanced against benefits and patient preferences.

    Future research efforts on recurrent UTI should focus on improving the design and reporting of trials and developing a core set of outcomes to allow better synthesis of trial data. Antibiotic prophylaxis should be compared with non-antibiotic prophylaxis with some evidence of efficacy rather than those with little or poor evidence of efficacy. Researchers should address unanswered questions regarding long-term effects, duration of use, adverse effects and antibiotic resistance.

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