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What Is The First Line Treatment For Urinary Tract Infection

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Symptoms Of Utis In Infants And Toddlers

Mayo Clinic Minute: Treating Urinary Tract Infections

UTIs in infants and preschool children tend to be more serious because they are more likely to involve the kidneys. Older children are more likely to have lower UTIs and standard symptoms. Infants and young children should always be checked for UTIs if the following symptoms are present:

  • A persistent high fever of otherwise unknown cause, particularly if it is accompanied by signs of feeding problems, listlessness, and fatigue.
  • Painful, frequent, and foul-smelling urine.
  • Cloudy urine.
  • A recurrence of bedwetting or poor urine control during the day in a child who previously had bladder control.
  • Abdominal and low back pain.
  • Vomiting and abdominal pain .

Specific Risk Factors In Men

Men become more susceptible to UTIs after the age of 50, when they begin to develop prostate problems. Benign prostatic hyperplasia , enlargement of the prostate gland, can produce obstruction in the urinary tract and increase the risk for infection. In men, recurrent UTIs are also associated with prostatitis, an infection of the prostate gland. Although UTIs are less common in men, they can cause more serious problems in men than in women. Men with UTIs are more likely to require hospitalization than women.

Use Of Antibiotics For Treating Utis In Dogs And Cats

JD Foster


Dr. Foster is an internist and Director of the Extracorporeal Therapies Service at Friendship Hospital for Animals in Washington, D.C. He has lectured around the world on various renal and urinary diseases and authored numerous manuscripts and book chapters on these topics. He is the current president of the American Society of Veterinary Nephrology and Urology.

Urinary tract infections are common in small animal practice it has been reported that up to 27% of dogs will develop infection at some time in their lives.1

Most UTIs are successfully treated with commonly used drugs, dosages, and administration intervals. However, infections can be challenging to effectively treat when they involve the kidneys and prostate . In addition, it can be difficult to create an appropriate antibiotic prescription in patients with kidney disease due to reduced drug clearance.

Understanding drug pharmacokinetics and pharmacodynamics is essential when determining the most effective antibiotic therapy. In addition, successful antimicrobial therapy requires appropriate choice of antibiotic, including dose, frequency, and duration .

Figure 1

  • Stranguria

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Treatment For Kidney Infections

People with uncomplicated kidney infections may be treated at home with oral antibiotics. Ciprofloxacin or another fluoroquinolone is typically given but other antibiotics, such as trimethoprim-sulfamethoxazole , may be used. People with moderate-to-severe acute kidney infection and those with severe symptoms or other complications may need to be hospitalized. In such cases, antibiotics are usually given intravenously for several days. Chronic pyelonephritis may require long-term antibiotic treatment.

Treatment Of Asb And Lower Utis In Pregnancy

Drugs for Urinary Tract Infections

Although UTI in pregnancy is generally considered complicated, treatment regimens for ASB and lower UTI in pregnancy may include those typically used for uncomplicated UTI and should be adapted to the patient’s individual risk and urine culture results.

  • Antibiotics that are potentially appropriate during specific stages of pregnancy include:
  • Nitrofurantoin for 5 days: Avoid close to the delivery date.
  • TMP/SMX for 3 days: Avoid during the first trimester and past 32 weeks’gestation.
  • Antibiotics that should be avoided include fluoroquinolones and aminoglycosides.
  • Follow-up culture should be considered a week after treatment for ASB and UTI.
  • Negative culture: no further treatment required unless new UTI symptoms develop
  • Positive culture: indicates persistent bacteriuria antibiotic therapy based on the culture results
  • Asymptomatic bacteriuria in pregnancy is a risk factor for pyelonephritis and should be treated.

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    Does Cranberry Juice Prevent A Uti

    Some patients may want to use cranberry or cranberry juice as a home remedy to treat a UTI. Cranberry juice has not been shown to cure an ongoing bacterial infection in the bladder or kidney.

    Cranberry has been studied as a preventive maintenance agent for UTIs. Studies are mixed on whether cranberry can really prevent a UTI. Cranberry may work by preventing bacteria from sticking to the inside of the bladder however, it would take a large amount of cranberry juice to prevent bacterial adhesion. More recent research suggests cranberries may have no effect on preventing a UTI

    • According to one expert, the active ingredient in cranberries — A-type proanthocyanidins — are effective against UTI-causing bacteria, but is only in highly concentrated cranberry capsules, not in cranberry juice.
    • However, cranberry was not proven to prevent recurrent UTIs in several well-controlled studies, as seen in a 2012 meta-analysis of 24 trials published by the Cochrane group.
    • While studies are not conclusive, there is no harm in drinking cranberry juice. However, if you develop symptoms, see your doctor. Some people find large quantities of cranberry juice upsetting to the stomach.

    Increasing fluid intake like water, avoiding use of spermicides, and urinating after intercourse may be helpful in preventing UTIs, although limited data is available.

    Editorial Sources And Fact

  • R Orenstein R, Wong ES. Urinary Tract Infections in Adults. American Family Physician. March 1999.
  • Anger J, Lee U, Ackerman AL, et al. Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. The Journal of Urology. August 2019.
  • Patient Education: Urinary Tract Infections in Adolescents and Adults . UpToDate. January 2020.
  • Huttner A, Kowalczyk A, Turjeman A, et al. Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women a Randomized Clinical Trial. Journal of the American Medical Association. May 2018.
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    Why Are Females At A Higher Risk For Utis

    People with female reproductive organs are at a higher risk for UTIs because of their anatomy. The female urethra, the tube which empties urine from your bladder out of your body, is shorter than someone born with male anatomy.

    The female urethra is also quite close to female reproductive organs. That means bacteria from sexual intercourse as well as products like spermicide can be in close contact with the urethra and bladder.

    Females also experience menopause and pregnancy. These two biological events change the bacteria in your reproductive and digestive tracts and create conditions that make UTIs more likely.

    Medications For Treating Symptoms

    Natural Treatments for Urinary Tract Infections

    Although antibiotics can cure most UTIs, severe symptoms can persist for several days until the drug eliminates the bacteria. Other medications may be used for relieving symptoms until the antibiotics take action.


    Phenazopyridine relieves pain and burning caused by the infection. People should not take this medicine for more than 2 days without discussing it with their doctor.

    Side effects include headache and upset stomach. The drug turns urine a red or orange color, which can stain fabric and be difficult to remove. Rarely, it can cause serious side effects, including shortness of breath, a bluish skin, a sudden reduction in urine output, and confusion. In such cases, people should immediately call the doctor.

    Antispasm Drugs

    Methenamine or flavoxate reduce bladder spasms, which may occur with some UTIs. However, these drugs can have severe side effects, which the person should discuss with the doctor.

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    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.
  • Asymptomatic Urinary Tract Infection

    An asymptomatic UTI is when a person has no symptoms of infection but has a significant number of bacteria that have colonized the urinary tract. The condition is harmless in most people and rarely persists, although it does increase the risk for developing symptomatic UTIs.

    Screening and treatment of asymptomatic bacteriuria is not usually necessary except for the following people:

    • Pregnant women. Pregnant women with asymptomatic bacteriuria have an increased risk of acute pyelonephritis in their second or third trimester. Therefore, they need screening and treatment for this condition. Guidelines recommend that pregnant women be screened for asymptomatic bacteriuria at 12 to 16 weeks gestation or at the first prenatal visit, if later.
    • People undergoing urologic surgery . The presence of an infection during surgery can lead to serious consequences.

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    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

    History And Physical Examination

    Urinary Tract Infections and Interstitial Cystitis

    Clinical signs and symptoms of a UTI depend on the age of the child. Newborns with UTI may present with jaundice, sepsis, failure to thrive, vomiting, or fever. In infants and young children, typical signs and symptoms include fever, strong-smelling urine, hematuria, abdominal or flank pain, and new-onset urinary incontinence. School-aged children may have symptoms similar to adults, including dysuria, frequency, or urgency. Boys are at increased risk of UTI if younger than six months, or if younger than 12 months and uncircumcised. Girls are generally at an increased risk of UTI, particularly if younger than one year.3 Physical examination findings can be nonspecific but may include suprapubic tenderness or costovertebral angle tenderness.

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    Trimethoprim Use For Urinary Tract Infection And Risk Of Adverse Outcomes In Older Patients: Cohort Study

  • Elizabeth Crellin, research assistant1,
  • Kathryn E Mansfield, research fellow1,
  • Clémence Leyrat, research fellow2,
  • Dorothea Nitsch, professor1,
  • Ian J Douglas, associate professor1,
  • Adrian Root, research fellow1,
  • Elizabeth Williamson, associate professor2,
  • Liam Smeeth, professor1,
  • Laurie A Tomlinson, associate professor1
  • 1Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
  • 2Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  • Correspondence to: K Mansfield
    • Accepted 16 January 2018

    International Clinical Practice Guidelines

    In 2010, a panel of international experts updated the 1999 Infectious Diseases Society of America guidelines on the treatment of acute uncomplicated cystitis and pyelonephritis in women. The panel reviewed the literature, including the Cochrane Database of Systematic Reviews, and provided an evidence-based guideline for women with uncomplicated bacterial cystitis and pyelonephritis.16,17 The IDSA collaborated with the European Society of Clinical Microbiology and Infectious Diseases, and invited representation from diverse geographic areas and a wide variety of specialties, including urology, obstetrics and gynecology, emergency medicine, family medicine, internal medicine, and infectious diseases. Levels-of-evidence ratings were assigned to recommendations on the use of antimicrobials for the treatment of uncomplicated UTIs.

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    Specific Risk Factors In Children

    UTIs are rare during infancy but they are much more common in boys than in girls. Boys who are circumcised are far less likely than uncircumcised boys to develop UTIs by the time they are 1 year old. After the age of 2 years, UTIs are more common in girls. As with adults, E. coli is the most common cause of UTIs in children.

    Vesicoureteral Reflux

    Vesicoureteral reflux is the cause of up to half of the UTIs that occur during childhood. VUR also puts children at risk for UTI recurrence.

    VUR is a condition in which the urine backs up into the kidneys. Normally, urine travels from the kidneys through the ureters, and into the bladder. When the bladder becomes filled, the muscle in the bladder wall contracts, and the urine leaves the body through another tube called the urethra. There is a valve-like mechanism at the point where the ureters join the bladder at an angle, through a tunnel under the mucosal lining. The job of these valves is to keep urine from flowing backward towards the kidneys when the bladder contracts. If the ureters enter the bladder through a shorter tunnel then these valves do not work well and urine may remain in the bladder where bacteria can grow. The backflow of urine may also carry any infection from the bladder up into the kidneys.

    A child may be:

    Nearly any kidney disorder, including kidney stones, increases the risk for complicated UTIs.

    Neurogenic Bladder

    Immune System Problems

    Urinary Tract Abnormalities

    What Other Antibiotics Are Used To Treat Uti

    Recurrent UTI in Women: AUA/SUFU Guidelines

    Other antibiotics used to treat UTI include:

    • Beta-lactams, including penicillins and cephalosporins . Many organisms have shown resistance to some of these drugs.
    • Trimethoprim-sulfamethoxazole combination antibiotic . Many organisms have shown resistance to some of these drugs.
    • Fluoroquinolones . The risk of antibiotic resistance to this is developing. These should not be given to pregnant women or children.
    • Tetracyclines are used for Mycoplasma or Chlamydia infections. These should not be given to pregnant women or children.
    • Aminoglycosides are usually used in combination with other antibiotics to treat severe UTIs.

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    Can I Treat A Uti Without Antibiotics

    UTI treatment without antibiotics is NOT usually recommended. An early UTI, such as a bladder infection , can worsen over time, leading to a more severe kidney infection . However, a small study has suggested early, mild UTIs might clear up on their own. It’s always best to check with your doctor if you are having UTI symptoms.

    Pregnant women should always see a doctor as soon as possible if they suspect they might have a UTI, as this can lead to a greater risk of delivering a low birth weight or premature infant.

    Other Antibiotics Used For Utis


    Doripenem is a newer carbapenem antibiotic, which is used to treat complicated UTIs and pyelonephritis. It is given by injection.


    Vabomere, a combination of a beta-lactam antibiotic and a penicillinase inhibitor , has been approved by the FDA in 2017 for the treatment of complicated UTIs, including pyelonephritis caused by E coli, Klebsiella pneumoniae, and Enterobacter cloacae. This drug is also given by injection.


    Tetracyclines include doxycycline, tetracycline, and minocycline. They may be used for UTIs caused by Mycoplasma or Chlamydia. Side effects include skin reactions to sunlight and permanent tooth discoloration. Tetracyclines cannot be taken by children or pregnant women.


    Aminoglycosides include gentamicin, tobramycin, and amikacin. They are given by injection for very serious bacterial infections. They can be given only in combination with other antibiotics. Gentamicin is the most commonly used aminoglycoside for severe UTIs. They can have very serious side effects, including damage to hearing, sense of balance, and kidneys.

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    What If I Have Frequent Recurring Utis

    Within a year of havig a UTI infection, roughy one-quarter to one-half of women will have another UTI. For these women antibiotic prophylaxis may be recommended by her health care provider. With a recurrent course of UTIs, a urine culture or imaging tests may be required for further analysis.

    For recurrent UTIs, there are several antibiotic options for prevention:

    • A shorter course of antibiotics at the first sign of UTI symptoms a prescription may be given to you to keep at home.
    • A longer course of low-dose antibiotic therapy.
    • Take a single dose of an antibiotic after sexual intercourse.

    The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost. Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, or cephalexin.

    In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective treatment. Treatment options your doctor might recommend include: Estring, Vagifem , or vaginal estrogen creams .

    Symptoms Of Utis In Older People

    Augmentin for urinary tract infection

    The classic lower UTI symptoms of pain, frequency, or urgency and upper tract symptoms of flank pain, chills, and tenderness may be absent or altered in older people with UTIs.

    Symptoms of UTIs that may occur in seniors but not in younger adults include mental changes or confusion, nausea or vomiting, abdominal pain, or cough and shortness of breath. A preexisting health condition may further confuse the picture and make diagnosis difficult.

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