Antiseptic Drug As Good As Antibiotics For Preventing Recurrent Urinary Tract Infections
And may also help tackle antibiotic resistance, say researchers
The antiseptic drug methenamine hippurate is as good as antibiotics for preventing recurrent urinary tract infections in women, finds a trial published by The BMJ today.
Its use as an alternative to antibiotics may also help tackle the global burden of antibiotic resistance, say the researchers.
Over half of women have at least one urinary tract infection in their lifetime, and recurrence occurs in about a quarter of women who have one episode.
Current guidelines recommend daily low dose antibiotics as the standard preventive treatment for recurrent UTI. But such long term use of antibiotics has been linked to antibiotic resistance, so research into non-antibiotic alternatives is urgently needed.
Methenamine hippurate is a drug that sterilises urine, stopping the growth of certain bacteria. Previous studies have shown that it could be effective in preventing UTIs, but the evidence is inconclusive and further randomised trials are needed.
So a team of UK researchers, led by clinicians and scientists from Newcastle-upon-Tyne, set out to test if methenamine hippurate is an effective alternative to standard antibiotic treatment for preventing recurrent UTI in women.
Their findings are based on 240 women with recurrent urinary tract infections requiring prophylactic treatment. On average before trial entry these women experienced over six UTI episodes per year.
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
Uti Antibiotics: Treatment For Urinary Tract Infection
Special Announcement July, 2022:
What are the best UTI antibiotics? What happens if antibiotics dont work? Can you treat a UTI without antibiotics?
Here is where we lay out everything you need to know about UTI antibiotics. If youve ever googled questions like
Should I take Amoxicillin for UTI?What are the best antibiotics for UTI?Is Macrobid for UTI appropriate?What happens if antibiotics dont work for UTI?Can you treat a UTI without antibiotics?
This article is for you. Even if you havent googled any of these, but have questions about antibiotics for UTI, this should have you covered.
Jump To Section:
- How UTI antibiotics are selected. > > > >
- What happens if antibiotics dont work for UTI? > > > >
- My UTI test results are negative, what now? > > > >
- Do I have recurrent UTI or Interstitial Cystitis? > > > >
- Can you break the UTI antibiotic treatment cycle? > > > >
We find people discuss UTI antibiotics as though this represents a single treatment option. In reality, UTI antibiotics refers to a whole range of different drugs and doses, selected for specific reasons.
Knowing why certain antibiotics are helpful and others arent will give you more control over your own treatment. So lets start at the very beginning. That way you can confirm the knowledge you already have, then expand on it.
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Complicated Pyelonephritis Related To Urinary Tract Obstruction
1) Background and epidemiology
Urinary tract obstruction is important in the pathophysiology of infectious pyelonephritis. When normal urine excretion is obstructed, bacteria are introduced into the urinary tract. In the presence of foreign substances such as urinary stones, a biofilm forms on the surface of the urinary tract and bacteriuria continues. In addition, the extent of kidney damage is proportional to the period of urinary tract obstruction, and the recovery function of the kidney gradually deteriorates. The urine-concentrating ability can be completely recovered if the urinary tract obstruction lasts no more than a week or so. However, if the condition continues for 4 weeks, the ability may be permanently lost . For UTIs resulting from urinary tract obstruction, prompt management of the urinary tract obstruction is needed in addition to antibiotic treatment for the infection itself, and an individualized approach should be made according to the causative disease .
3) Guideline by key question
What are appropriate empirical antibiotics for initial administration in adult patients with complicated pyelonephritis related to urinary tract obstruction?
Antibiotics Used For Uncomplicated Utis
If you are a healthy individual whose urinary tract is anatomically and functionally normal and you have no known heightened UTI susceptibility youve got whats dubbed an uncomplicated UTI, according to guidelines published in August 2019 in the Journal of Urology. For these individuals, antibiotics are considered the first-line of treatment.
The type of antibiotics you are prescribed and for how long is contingent on the type of bacteria detected in your urine, your current health status, and whether your UTI is uncomplicated or complicated. Depending on which antibiotic your doctor prescribes, women may need a single dose or up to a five-day course. For men, antibiotics are usually given for a slightly longer period of time, notes UpToDate.
Typically, if you are diagnosed with an uncomplicated UTI, one of the following will be prescribed as first-line treatment:
The following antibiotics are considered second-line treatments for UTI. They are generally chosen because of resistance patterns or allergy considerations:
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Amoxicillin/potassium Clavulanate Cefdinir Or Cephalexin
How it Works: is another combination drug that belongs to the penicillin class of antibiotics. and belong to a different class of antibiotics thats closely related to penicillins.
All three antibiotics kill bacteria by destroying one of its most important components: the cell wall, which normally keeps bacteria structurally intact.
Amoxicillin/clavulanate: 500 twice a day for 5 to 7 days
Cefdinir: 300 mg twice a day for 5 to 7 days
Cephalexin: 250 mg to 500 mg every 6 hours for 7 days
Notable side effects: Diarrhea, nausea, vomiting, and rash are common side effects of these antibiotics. In rare cases, all three have the potential to cause the dangerous skin reactions, SJS and TEN.
If you have a penicillin allergy, your healthcare provider wont prescribe amoxicillin/clavulanate. They may or may not prescribe cefdinir or cephalexin since there is a small chance that a person with a penicillin allergy may also be allergic to these two.
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What Is A Uti
Before we talk about the antibiotics that treat UTIs, lets discuss what the medications are targeting.
Urinary tract infections, or UTIs, refer to a group of infections that can happen anywhere along the urinary tract, which includes the kidneys, ureters, bladders, and urethra. Antibiotics are used to treat UTIs because bacteria often cause themEscherichia coli is the type of bacteria notoriously famous for causing most UTIs.
Most germs that cause these infections typically live on the skin in unharmful numbers, especially in areas like the vaginal folds. However, once in the urinary tract, they can multiply to unsafe colony numbers and cause symptoms .
UTI symptoms include: burning during urination, needing to pee frequently, lower abdominal pain or cramping, blood in your urine, and feeling the need to urinate even if you just went to the bathroom.
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Availability Of Data And Materials
The data that support the findings of this study are available from the KUHR database and NorPD, but restrictions apply to the availability for these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and provided permission is granted from the KUHR database and NorPD.
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 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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Can You Test For Interstitial Cystitis
At a certain point, when UTI tests fail to identify a bacterial cause for symptoms, a diagnosis of recurrent UTI is escalated to IC for many individuals.
We know standard UTI testing methods are inaccurate. So there is a good chance a significant number of people are misdiagnosed with IC after receiving a false-negative on their test results. They may have an infection that testing has simply failed to pick up.
|I was told my urine culture was negative, and I therefore didnt have an infection. I was subsequently diagnosed with IC, but occasionally, during a symptoms flare, I would be culture positive. Eventually I pursued better testing, and found Id probably had an infection the whole time. Im slowly recovering, with treatment, and Im glad I didnt accept my diagnosis in the end.|
A number of researchers now believe many cases of Interstitial Cystitis may indeed be caused by bacteria that standard UTI testing has failed to identify.
Read more about Interstitial Cystitis and chronic infection testing and treatment in a dedicated section from our interview with Ruth Kriz.
If you have received inconclusive or negative test results, despite symptoms of a UTI, we encourage you to keep pushing for an answer. Seek better testing and find a practitioner who is willing to work with you.
The Process Of Treatment Guideline Development
The committee determined the method of treatment guideline development. The basic objective was to update the Korean guideline developed in 2011. For the existing key questions from the guideline, study findings that were published after the guideline was developed in 2011 were searched and added to the guideline, and the level of recommendation was determined. In addition, important questions that required additional findings were answered using the adaptation method. For questions regarding uncomplicated cystitis, the adaptation method was used. For the remaining four diseases, key questions were summarized and partially revised in the guideline.
1) Guideline search
Guidelines for the five diseases that were developed after 2011 were searched in the National Guideline Clearinghouse and OVID MEDLINE. They were searched using disease names on the NGC, and using Mesh terms related to the diseases and guideline search filters on MEDLINE . Search results are shown in . Two committee members selected seven guidelines for the five diseases from the search results.
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Symptoms Of Urinary Tract Infections
During the first stage, the urinary tract infection might not show any symptoms. It is only when the bacteria have invaded the urinary tract that symptoms appear. There are two types of urinary tract infections, and the symptoms are different.
An upper urinary tract infection comes with:
- Lack of appetite
- Drinking more water than usual
A lower urinary tract infection will present symptoms such as:
- The dog is in pain when urinating
- The urine might contain traces of blood
- The dog urinates significantly more than usual
- The dog tries to urinate, but cannot
Vitamin C Kills Harmful Bacteria
Foods and fruits rich in vitamin C boosts immunity and prevents the growth of harmful bacteria in the urinary tract. It also makes the urine acidic enough to kill the infection-cause. So, any man who is already suffering from urinary tract infection must have foods that are enriched with vitamin C. Mango, papaya, strawberries, watermelon, kiwi, grapefruit, orange, berries, pineapple, cantaloupe are some of the fruits that are the rich sources of vitamin C. Other than these, you should also make broccoli, bell peppers, cauliflower, and tomatoes integral to your regular diet. This way, you will keep yourself safe from the troubles of urinary tract infections.
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A Pharmacist Can Help With Utis
You can ask a pharmacist about treatments for a UTI. A pharmacist can:
- offer advice on things that can help you get better
- suggest the best painkiller to take
- tell you if you need to see a GP about your symptoms
Some pharmacies offer a UTI management service and can prescribe antibiotics if theyre needed.
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Medications For Treating Symptoms
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.
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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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.
What Are Potential Side Effects Of Antibiotics For Uti
In addition to the notable side effects weve already covered, there are a few more potential antibiotic side effects youll want to know about.
Most antibiotics can cause some degree of stomach upset like nausea, vomiting, and/or diarrhea. If you have severe diarrhea or diarrhea that lasts for 2 or more days, let your healthcare provider know. Diarrhea is a common side effect while taking antibiotics and just after finishing them. But in some cases, diarrhea from antibiotics can be a sign of a more serious infection caused by Clostridium difficile bacteria.
Some people are also sensitive to antibiotics, which could result in a minor reaction like a rash or a more serious reaction like anaphylaxis. If you notice difficulty breathing or major skin changes after taking an antibiotic, get medical help right away.
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
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Why Should I Take The Full Dose
Antibiotics work well against UTIs. You might start to feel better after being on the medicine for just a few days.
But even so, keep taking your medicine. If you stop your antibiotics too soon, you wonât kill all the bacteria in your urinary tract.
These germs can become resistant to antibiotics. That means the meds will no longer kill these bugs in the future. So if you get another UTI, the medication you take might not treat it. Take the full course of your medicine to make sure all the bacteria are dead.
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Treatment Of Bladder Urinary Tract Infections
The specific intervention depends on the severity of the symptoms. In many instances, healthy patients who have a urinary tract infection but have no symptoms require no treatment at all. Such asymptomatic UTIs typically resolve within two to three days.
If urinary tract infection symptoms are presentsuch as a burning sensation during urination or an increased need to urinatetreatment usually consists of antibiotic medications, which are prescribed for three to 14 days. They include:
- Trimethoprim: Trimethoprim is the standard treatment for urinary tract infections in otherwise-healthy adults. It is one of the more potent UTI antibiotics, so most patients only require a three-day course. Trimethoprim is generally well-tolerated with few side effects, which generally include nausea, vomiting, diarrhea/constipation or stomach pain.
- Nitrofurantoin: Nitrofurantoin is the second most commonly prescribed antibiotic for bladder UTIs. It usually requires a longer course than trimethroprim , and is usually well tolerated but should not be taken by anyone with kidney disease. Side effects include nausea and vomiting.
- Cephalosporins: Cephalosporins are often used as a first-line of treatment in patients that have upper urinary tract infections involving the ureters or kidneys. It is usually taken for seven to 10 days. Side effects include nausea, vomiting, upset stomach and diarrhea.
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