Choosing the Right UTI Antibiotics: What You Need to Know

Choosing the Right UTI Antibiotics: What You Need to Know

Urinary tract infection (UTI) is a condition where bacteria invade and grow in the urinary tract, causing an infection. This includes the infection of the bladder, ureters, urethra and kidneys.

It is important to treat UTIs timely and effectively to prevent complications and the spread of the infection to other areas of the urinary tract as well as other parts of the body, causing a systemic infection.

Antibiotics are commonly used to treat UTIs and in this article, we will explore more about the several antibiotics indicated for UTI.

Overview and Types of Urinary Tract Infections (UTI)

UTIs can affect any area of the urinary tract and the types of UTIs include:

Cystitis

    • Infection of the bladder
    • Usually due to bacteria from feces entering the urethra (tube that carries urine out of the body)
    • More common in females due to shorter length of urethra, allowing bacteria to reach the bladder more easily
    • May be caused by:
      • Sex
      • Wiping from back to front after a bowel movement
      • Urinary catheters
      • Spermicidal contraception
      • Kidney stones
      • Pregnancy
      • Diabetes 
    • Symptoms include:
      • Increase in frequency of urination
      • Lower abdominal pain
      • Stinging or burning sensation when urinating
      • Foul-smelling, cloudy or bloody urine 

Pyelonephritis:

    • Infection of the kidneys
    • Usually a complication from cystitis, where bacteria travels up the bladder then further up into the kidneys
    • May be caused by:
      • Cystitis
      • Kidney stones
      • Diabetes
      • Weakened immune system
    • Symptoms include:
      • Increase in frequency of urination
      • Stinging or burning sensation when urinating
      • Foul-smelling, cloudy or bloody urine 
      • Lower back, flank and abdominal pain

Urethritis:

    • Infection of the urethra 
    • Usually caused by a sexually transmitted infection (STI) such as chlamydia
    • May be caused by:
      • Unprotected sex with someone that has the STI
      • Rarely, damage to the urethra, e.g. from catheter use
    • Symptoms include:
      • Pain or burning sensation when urinating
      • White or cloudy discharge from the vagina or penis
      • An irritated or sore tip of the penis for males

Role of Antibiotics in UTI Treatment

As the main culprit of UTIs is bacteria, antibiotics are the mainstay treatment. Antibiotics can either be bactericidal or bacteriostatic, meaning they can either kill or inhibit the growth of bacteria. These antibiotics can have different mechanisms of actions and may include:

  • Inhibition of bacterial cell wall synthesis
  • Inhibition of bacterial protein synthesis
  • Inhibition of bacterial DNA replication
  • Targeting other bacterial metabolic pathways

Different antibiotics have different target organisms. Only certain antibiotics are effective against the few bacteria that cause UTIs and it is important that we select the appropriate antibiotics for each condition. This not only ensures targeted treatment, but also prevents unnecessary side effects and risk of developing antibiotic resistance.

Antibiotic resistance is a global concern. It occurs when bacteria no longer respond to antibiotics, the common causes include over-prescribing of antibiotics, patients not completing their antibiotic course and over-use of antibiotics in livestock and fish farming. The emergence and spread of these antibiotic-resistant bacteria threatens our ability to treat common infections, increasing the risk of disease spread, severe illness, disability and death. As such, it is crucial that we use antibiotics wisely.

Factors Influencing Antibiotic Choice

The choice of antibiotic differs based on the pathogens that have to be covered. This will depend on various factors such as:

Type of UTI 

Uncomplicated UTI typically refers to infection in an afebrile non-pregnant immunocompetent female patient.

On the other hand, a complicated UTI will involve infections in immunocompromised patients, males, pregnant women, as well as those also presenting with fevers, stones, urinary obstruction, catheter use, or involvement of the kidneys.

Patient factors 

Patient factors such as age, gender and allergies will also affect the choice of antibiotics. Aging may alter the body’s ability to absorb, distribute, metabolise and eliminate the drug, as well as how the body reacts to it. Older patients may be more frail and will generally be prescribed antibiotics that have a lower risk of allergic reactions or unwanted effects on other body organs. 

Patients with comorbidities that affect kidney or liver function may also affect the rate at which antibiotics are metabolised and eliminated from the body, extra caution is required when selecting the appropriate antibiotic in these populations.

Microbial factors

It is important to identify the causative bacteria and its susceptibility to antibiotics so that we can select the most effective antibiotic and prevent the development of antibiotic resistance.


Commonly Prescribed Antibiotics for UTIs

Generally, most diagnosed UTI cases will receive treatment with first-line antibiotics. However, in the case of allergies or intolerance to any of the first-line agents, some people may qualify for the use of second-line antibiotics. The duration of treatment varies between complicated and uncomplicated UTIs.


Antibiotics

Dosage

Side effects

First 

Line

Nitrofurantoin

100mg twice daily

Nausea, headache

Trimethoprim-

Sulfamethoxazole 

160/800mg twice daily

Rash, urticaria, nausea, vomiting, hematologic

Fosfomycin trometamol

3g as a single dose

Diarrhea, nausea, headache

Second Line

Fluoroquinolones

Ciprofloxacin

Dose varies by agent

Nausea, vomiting, diarrhea, headache, drowsiness, insomnia

β-lactams

Amoxicillin/Clavulanate

Dose varies by agent

Diarrhea, nausea, vomiting, rash, urticaria

Antibiotic Resistance and UTI Treatment

Antibiotic resistance is a global public health problem and is the cause of severe infections, complications, longer hospital stays, more frequent readmissions and increased need for medication use in self-limiting conditions.

Antibiotic resistance occurs when bacteria evolve to become immune to antibiotics that were previously able to kill them or inhibit their growth. They can do so via several mechanisms such as neutralizing components of antibiotics which render them ineffective, or modify their own structure or receptor so that antibiotics can no longer target and bind to them. In addition, resistance can also occur when bacterial genetic material becomes mutated. This development of resistance may then be passed down as the bacteria reproduces and multiply.

Commonly, the overuse and misuse of antibiotics occur when antibiotics are mistakenly prescribed to treat viral infections. As such, it is important to advocate for judicious use of antibiotics and only use them when a proper diagnosis of bacterial infection is established.

Best Practices for Antibiotic Use in UTIs

Upon an established diagnosis of a bacterial infection by a doctor, the onus is also on the consumer of the antibiotics to comply with the prescribed dosage and duration of the antibiotics. 

Antibiotics should be taken as prescribed, even if symptoms seem to have improved. Incomplete course of treatment may cause the remaining bacteria to develop resistance to the antibiotic taken, hence complicating the case further.

A follow-up and monitoring plan should be discussed with your primary care provider to ensure adequate treatment and prevention of recurrence.


UTI Prevention

While UTIs are bothersome, there are many management strategies that you may adopt to reduce their recurrence. These include:

  1. Drink plenty of fluid to flush the bacteria
  2. Urinate frequently and go when you first feel the urge
  3. Urinate shortly after sex to flush away bacteria that might have entered urethra during sex
  4. After using the toilet and especially after a bowel movement, always wipe from front to back
  5. Wear cotton underwear and loose-fitting clothes so that air can keep the area dry, avoid tight-fitting jeans and nylon underwear as they trap moisture and encourage growth of bacteria
  6. For women, using a diaphragm or spermicide for birth control can lead to UTI by increasing bacteria growth. Consider modifying birth control methods if possible

LactoCran+ Premium Cranberry Probiotics 30's

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Conclusion

Selecting the appropriate antibiotic for UTI treatment is crucial in ensuring proper management of UTIs and healthcare providers play a pivotal role. The importance of a proper diagnosis and antibiotic stewardship by healthcare professionals cannot be overstated.

At Glovida-Rx, our knowledgeable pharmacists are always happy to assist you with any queries or concerns regarding UTIs and its treatment with antibiotics. We believe in providing personalized and holistic care to all our customers. Regardless of whether you require medication-related advice or non-medication related tips to approach UTIs, do not hesitate to contact us at +65 8101 5555!

 

References

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2. Cleveland Clinic. (2023, April 6). Urinary Tract Infections . Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9135-urinary-tract-infections

3. Commissioner, O. of the. (2020). Combating Antibiotic Resistance. FDA. https://www.fda.gov/consumers/consumer-updates/combating-antibiotic-resistance#:~:text=It%27s%20important%20to%20take%20the%20medication%20as%20prescribed%20by%20your

4. Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G., Moran, G. J., Nicolle, L. E., Raz, R., Schaeffer, A. J., & Soper, D. E. (2011). International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103–e120. https://doi.org/10.1093/cid/ciq257

5. Habboush, Y., & Guzman, N. (2022). Antibiotic Resistance. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513277/#:~:text=Antibiotic%20resistance%20occurs%20when%20bacteria

6. Llor, C., & Bjerrum, L. (2014). Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety, 5(6), 229–241. https://doi.org/10.1177/2042098614554919

7. Luca Soraci, Cherubini, A., Paoletti, L., Filippelli, G., Luciani, F., Pasqualina Laganà, Maria Elsa Gambuzza, Filicetti, E., Corsonello, A., & Lattanzio, F. (2023). Safety and Tolerability of Antimicrobial Agents in the Older Patient. https://doi.org/10.1007/s40266-023-01019-3

8. National Cancer Institute . (2011). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/urinary-tract-infection#. 

9. NHS. (2017, October 23). Urethritis. Nhs.uk. https://www.nhs.uk/conditions/urethritis/#:~:text=Causes%20of%20urethritis

10. NHS. (2018, January 8). Kidney infection. Nhs.uk. https://www.nhs.uk/conditions/kidney-infection/

11. NHS . (2019). Cystitis. NHS. https://www.nhs.uk/conditions/cystitis/

12. Sabih, A., & Leslie, S. W. (2023, November 12). Complicated urinary tract infections. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK436013/

13. UC San Diego. (n.d.). Urinary Tract Infections. Studenthealth.ucsd.edu. https://studenthealth.ucsd.edu/resources/health-topics/urinary-tract-infections/index.html#:~:text=An%20infection%20in%20the%20urethra

14. World Health Organization. (2023, November 21). Antimicrobial Resistance. Www.who.int. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=As%20a%20result%20of%20drug

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