Each year, health care professionals treat over 8 million people with urinary tract infections (UTI). Although viral and fungal UTIs are possible, UTI’s most commonly occur when bacteria infiltrate the bladder via the urethra, the small tube that takes urine from the bladder to its exit.
To stop a UTI, you need to stop the bacteria. It’s not as straightforward as it sounds due to the myriad types of bacteria that may be to blame for the average UTI, and there is no one-size-fits-all antibiotic treatment for a UTI. In fact, physicians have an assortment of antibiotics at their disposal.
The best antibiotic treatment for UTI, therefore, is one that considers the diverse set of factors informing your situation as a patient.
How Common Are UTIs?
According to the National Kidney Foundation, 20% of women will experience a UTI at some point in their life. Of those, one in five will have a second UTI, and 30% of that narrowed group will have a third. Additionally, 80% of women who have three UTIs will have repeat infections after that.
Men also experience UTIs, but far less frequently. Contrary to popular belief, you do not have to be sexually active to get a UTI, although it does increase your likelihood as intercourse can facilitate the spread of bacteria.
Why Do Women Get UTIs More Often Than Men?
Women are more susceptible to getting a UTI thanks to their anatomy. Their urethras are both closer to the rectum and shorter in length than men’s urethras are; they’re also near the vagina. In other words, women’s bodies naturally present a convenient access point for the myriad bacteria that commonly cause UTIs.
Who Else Has a Higher Risk of a UTI?
There are a handful of other factors that can boost your odds of developing a UTI. They include:
- Age (both seniors and children are more likely to have UTIs)
- Pregnancy
- Obesity
- Uncontrolled or inadequately controlled diabetes
- Certain forms of birth control, such as diaphragms that put pressure on the urethra
- Being sexually active, particularly with a new partner
- Anatomical abnormalities or blockages along the urinary tract, such as kidney stones
- Enlarged prostate
Because UTIs are so common, they’re also subject to a greater spread of misinformation than other conditions. Contrary to myth, you cannot get a UTI from using tampons or sanitary napkins, wearing tight clothing, riding a bike, or failing to urinate after intercourse.
What Are the Most Common UTI Symptoms?
Frequent and painful urination are two of the most well-known symptoms of a UTI, but they aren’t the only ones. (It’s also possible, but uncommon, to experience no symptoms at all.) In general, the symptoms of a UTI vary according to what part of your urinary tract is affected.
Bladder
Also known as cystitis, this type of UTI may result in:
- Lower abdominal discomfort
- Pain in your back or sides
- Frequent urination
- Painful urination
- Pelvic pressure and/or cramping (women)
- Rectal pain (men)
- Feeling that you need to urinate even when your bladder is empty
- Bloody urine
Urethra
When a UTI occurs in the urethra itself, it often results in a burning sensation during urination and/or discharge. This type of UTI is known as urethritis.
Infections of the urethra and of the bladder are both lower urinary tract infections. These are more common and typically less severe than upper-tract UTIs. As many as 50 to 70% of lower-tract UTIs clear on their own without treatment, although it may take several months and patience should never be a substitute for a skilled diagnosis and treatment.
If you suspect you have a UTI, you should always contact a healthcare provider. A routine UTI can turn into a more serious infection if left untreated; a lower-tract UTI can migrate to the kidneys, for example, and become an upper-tract infection.
Kidneys
Acute pyelonephritis, or a UTI that manifests in the kidneys, presents a somewhat unexpected range of symptoms that may not immediately register as signs of a UTI. They include:
- Nausea
- Vomiting
- Fever
- Pain the middle of your back, to the left or right of your spine
- Chills
- Fatigue
Upper-tract UTIs can be fatal when ignored, as the bacteria present may enter the bloodstream, causing urosepsis. Urosepsis can lead to shock, an extreme drop in blood pressure and, in some instances, death.
What’s the Difference Between Complicated and Uncomplicated UTIs?
There’s more to choosing the best antibiotic treatment for UTI than determining the infection’s location. UTIs are also split into two categories — uncomplicated and complicated — based on the health of the urinary tract itself, the patient’s anatomy, and a handful of other mitigating factors.
Uncomplicated
As the name suggests, an uncomplicated UTI is one that occurs in a female patient whose urinary tract is otherwise normal and free of disease or any other elements that may complicate matters, including the ability to provide safe and effective treatment.
Complicated
If your UTI is deemed “complicated,” this means you have some other issue(s) with your urinary tract that may make treatment more complex. There are a variety of factors that may cause a UTI to be classified as complicated. Examples include:
- Anatomical anomalies, such as a narrow urethra
- Pregnancy
- Blockage somewhere along the urinary tract, such as kidney stones
- A compromised immune system due to chemotherapy, diabetes or other causes
- The presence of abnormal or unexpected bacteria
- Recurring UTIs that aren’t responding well to treatment
- Being age 65+
UTIs in men are considered complicated by default.
How Are Most UTIs Diagnosed?
There are several ways that your physician can diagnose a UTI. To provide the best antibiotic treatment for UTI, he or she needs to determine the location of the infection and whether your UTI is complicated. He or she also needs to rule out other conditions that present similarly to UTI, such as vaginitis or certain sexually transmitted diseases.
Most UTIs are diagnosed via urine test. In some instances, your healthcare provider may also order blood cultures and a complete blood count. These test results will confirm the type of bacteria, virus or fungus that’s causing the infection.
Bacteria is to blame for the vast majority of UTIs, and they’re treated using a wide range of antibiotics. In rarer cases, where a virus is behind the infection, antivirals such as cidofovir are prescribed. Fungal UTIs are treated with antifungals.
Recurrent UTIs and Further Testing
If you’re experiencing recurrent UTIs, your doctor may want to get a better look to rule out the possibility of an obstruction. Exams used in these instances include:
- An abdominal ultrasound, which uses ultrasound waves to produce an image of your urinary tract
- IVP, or an X-ray image of your urinary tract enhanced by dye
- A CT scan, which takes precise, detailed pictures of your urinary tract
- Cystoscopy, where your physician inserts a tiny camera via your urethra so he or she can examine the bladder and/or get a tissue sample
UTIs are considered recurrent if you experience three infections within a 12-month period or two within six months.
Can Doctors Treat UTIs Via Telemedicine?
Telemedicine is an increasingly popular method of treating UTIs. In addition to being convenient, it’s also discreet and frequently more affordable than an in-office visit.
Since doctors can’t collect a urine specimen via telemedicine, they will typically make their diagnosis using a series of questions that identify and analyze your symptoms. Your telehealth provider will also want to know if you have a history of UTIs, as well as if there are any other factors that may complicate your UTI, such as pregnancy or a chronic health condition.
Ultimately, the fact that UTIs are extremely common assists physicians in their ability to accurately diagnose and treat UTIs online. In the event that your UTI symptoms present themselves as more severe or as something else entirely, your telemedicine professional will instruct you to visit another physician in the office for a follow-up or to perform a urinalysis. Most of the time, however, your telehealth provider can diagnose your infection and prescribe antibiotics via video alone. Certain telehealth providers may be able to fill your prescription as well, which can save you the expense of going through a pharmacy.
What Antibiotics Are Used To Treat Bacterial UTIs?
Once your physician has determined the location of your UTI and whether it’s complicated, he or she will likely suggest an antibiotic for treatment. Infections in the lower urinary tract are typically treated with oral medication (capsules, tablets, powders), while upper-tract UTIs usually merit intravenous (IV) antibiotics.
All antibiotics require a prescription. This is, in part, to avoid the potential for antibiotic misuse, which can result in your body forming a dangerous resistance to antibiotics. It’s also a way to ensure that you visit a healthcare provider when you have symptoms. If left untreated, even an uncomfortable but harmless lower-tract UTI can become more severe, particularly if it’s allowed to travel further up the urethra and take up residence in your kidneys.
Treatment for Uncomplicated UTIs
If you’re an otherwise healthy woman who isn’t pregnant and hasn’t entered menopause, your doctor may prescribe one of the following antibiotics to resolve an uncomplicated UTI.
1. Trimethoprim or Trimethoprim-Sulfamethoxazole
These synthetic, oral antibiotics — often shortened to TMP and TMP-SMX — are common first options for treatment due to their cost and their efficacy. A three-day regimen is typical.
Typical dose: 100-milligram tablet every 12 hours or 200-milligram tablet every 24 hours
Most common side effects:
- Itching
- Photosensitivity
- Headache
- Swollen tongue
- Nausea and/or vomiting
- Diarrhea
- Loss of appetite
- Fever
- Rash
2. Fosfomycin
Fosfomycin distinguishes itself from the other antibiotics on this list by the fact that a single dose may be all that’s required to clear up some patients’ UTIs. Although less frequently prescribed in the United States, it has been a common treatment option in Europe since the late 1980s.
Fosfomycin also stands out because it’s available as a powder. Patients dissolve the contents of a prescribed powder packet in 4 ounces of water, then drink it immediately.
Typical dose: 3 grams (one packet)
Most common side effects:
- Itching
- Thick, white discharge (mildly odorous or completely odor-free)
- Pain during intercourse
3. Nitrofurantoin
Nitrofurantoin is another route your doctor might take, and it’s available as a capsule or a liquid. The main difference between this antibiotic and those listed above is that it requires five to seven days to work. Because it’s been shown to exacerbate preexisting pulmonary issues, it’s typically not recommended for use by elderly patients.
Typical dose: 50 to 100 milligrams four times a day or 100 milligrams every 12 hours for seven days
Common side effects:
- Itching
- Headache
- Abdominal pain
- Nausea and/or vomiting
- Diarrhea
- Loss of appetite
- Change in urine color
- Rash
4. Fluoroquinolones (Ofloxacin, Norfloxacin, Fleroxacin, Levofloxacin, Ciprofloxacin and others)
Antibiotics in this family aren’t typically used as the initial step in treating a lower-tract UTI because they present a greater risk of the patient developing a resistance to antibiotics. They’re also more expensive than other options. For patients who cannot take TMP-SMX, fosfomycin or nitrofurantoin, however, a three-day course of treatment with drugs of this type, typically administered in tablet form, can be very effective in ending a UTI.
Typical dose: Varies by medication
Common side effects:
- Itching
- Vaginal discharge
- Headache
- Nausea and/or vomiting
- Diarrhea
- Abdominal pain
- Abnormal liver function test results
5. ß-Lactams (Amoxicillin, Ampicillin, Cefadroxil, Cephalexin, Cephradine, Cefuroxime axetil, Pivmecillinam and others)
Like TMP, TMP-SMX and fluoroquinolones, drugs in this group are typically prescribed as a three-day treatment. Unlike those antibiotics, ß-lactams are generally less effective in treating UTIs, as more and more types of bacteria develop a resistance to antibiotics.
ß-lactams in the penicillin family, such as amoxicillin, have been particularly affected by this decrease in antibiotic response. Because of this, ß-lactams are typically reserved as an alternate form of treatment. They’re commonly prescribed to pregnant women with UTIs, for example, as a safe alternative to other drugs.
Typical dose: Varies by medication
Common side effects:
- Nausea and/or vomiting
- Diarrhea
- Oral thrush
- Vaginal yeast infection
- Rash
Treatment for Complicated UTIs
If your UTI is considered complicated due to extenuating circumstances, your doctor will likely still prescribe an antibiotic, but your course of treatment may be different. For example, while UTIs are common during pregnancy — especially in the lower urinary tract — pregnant women typically require a longer course of treatment, regardless of which type of antibiotic is used. The antibiotics prescribed vary according to which trimester the expectant mother is in, too. TMP, for instance, isn’t used during the first trimester.
In short, if your UTI is informed by extenuating circumstances, expect your physician to take those into account as he or she determines what antibiotics may be the safest and most effective, as well as how long you need to take them.
Treatment Length for All UTIs
No matter what kind of bacterial infection you have and where it’s located, the best antibiotic treatment for UTI is generally the shortest one. This is to lower your odds of developing antibiotic resistance and to decrease your risk of a yeast infection or infectious diarrhea.
Still, it’s imperative that you take all the antibiotics prescribed, even after symptoms subside. Most UTIs resolve within three to 10 days. Stopping your antibiotics early, before the drugs eliminate all bacteria, can create a breeding ground for antibiotic-resistant bacteria, too.
Do Cranberries Cure UTIs?
No home remedies for UTIs exist. Drinking water can help to flush the infection from your body faster, and keep you hydrated (thus better equipped to fight the infection) for example, but it’s not a “cure.”
Similarly, cranberries are not a UTI remedy, although there’s limited proof suggesting compounds present in cranberries, including sulfuric acid, may decrease the likelihood of repeat UTIs in women because they prevent certain bacteria from latching onto the wall of the urinary tract.
Between cranberry juice, cranberry extract and various cranberry supplements, no cranberry products are any “better” or more effective than others, as none have been specifically studied. That said, if you do seek out cranberry juice, opt for unsweetened cranberry juice, not cranberry juice cocktail.
Is There Any Other Way To Prevent a UTI?
While there’s no foolproof way to ensure you never have a UTI, there are strategies and behaviors that may lower your risk:
- Stay hydrated.
- Don’t wait for extended periods of time to urinate.
- Take showers instead of baths.
- Empty your bladder before going to bed.
- Maintain a healthy weight.
- Women should wipe from front to back to stop the spread of bacteria.
- Avoid using douches, powders, sprays or other materials in the genital area.
Some physicians have begun recommending that patients add probiotics to their diet — such as kefir, yogurt, various fermented foods, etc. — as a form of prevention. No evidence indicates that probiotics can prevent a UTI on their own, but they do promote the growth of helpful bacteria in the vagina and bowels, which is beneficial for your overall health and may lower your risk of infection.
UTIs are commonplace — so commonplace, in fact, that they’re one of the most frequently treated issues by telehealth professionals. If you’re experiencing symptoms consistent with a UTI, don’t wait until your schedule clears up to make an appointment with a physician. Don’t wait for your doctor’s next in-office opening six weeks from now, either.