Medications - Antiobiotics:

Although antibiotics are the first treatment choice for urinary tract infections,
antibiotic-resistant strains of E. coli, the most common cause of UTIs, are
increasing worldwide. As more bacteria have become resistant to the
standard UTI treatment trimethoprim-sulfamethoxazole (TMP-SMX), more
doctors have prescribed quinolone antibiotics to treat UTIs. In some areas,
quinolones have now overtaken TMP-SMX as the most commonly prescribed
antibiotic for UTIs. Researchers are concerned that resistance may develop
to these drugs as well.

The following are some of the antibiotic classes used most commonly to treat
UTIs:

Beta-Lactams
The beta-lactam antibiotics share common chemical features and include
penicillins, cephalosporins, and some newer similar drugs.

Penicillins (Amoxicillin). Until recent years, the standard treatment for a UTI
was 10 days of amoxicillin, a penicillin antibiotic, but it is now ineffective
against E. coli bacteria in up to 25% of cases. A combination of amoxicillin-
clavulanate (Augmentin) is sometimes given for drug-resistant infections.
Amoxicillin or Augmentin may be useful for UTIs caused by Gram-positive
organisms, including Enterococcus species and S. saprophyticus.

Cephalosporins. Antibiotics known as cephalosporins are also alternatives for

infections that do not respond to standard treatments or for special
populations. They are often classed as first, second, or third generation.
Cephalosporins used for treatment of UTIs include cephalexin (Keflex),
cefadroxil (Duricef) cefuroxime (Ceftin),loracarbef (Lorabid), and cefixime
(Suprax, among others.

Other Beta-Lactam Drugs. Other beta-lactam antibiotics have been

developed. For example, pivmecillinam (a form of mecillinam), is commonly
used in Europe for UTIs.

Trimethoprim-Sulfamethoxazole (TMP-SMX)
The typical treatment is a 3-day course of the combination drug
trimethoprim-sulfamethoxazole, commonly called TMP-SMX (such as Bactrim,
Cotrim, or Septra). A 1-day course is somewhat less effective but poses a
lower risk for side effects. Longer courses (7 - 10 days) work no better than
the 3-day course and have a higher rate of side effects.

TMP-SMX should not be used in patients whose infections occurred after

dental work or in patients allergic to sulfa drugs. Allergic reactions can be
very serious. Trimethoprim (such as Proloprim or Trimpex) is sometimes
used alone in those allergic to sulfa drugs. TMP-SMX can interfere with the
effectiveness of oral contraceptives. High rates of bacterial resistance to
TMP-SMX exist in many parts of the United States.

Fluoroquinolones (Quinolones)
Fluoroquinolones (also simply called quinolones) are now becoming as widely
used as TMP-SMX. They are the standard alternatives to TMP-SMX. Examples
of quinolones include ofloxacin (Floxacin), ciprofloxacin (Cipro), norfloxacin
(Noroxin), and levofloxacin (Levaquin).
Pregnant women should not take fluoroquinolone antibiotics. They also have
more adverse effects in children than other antibiotics and should not be the
first-line option in most situations.

Tetracyclines
Tetracyclines include doxycycline, tetracycline, and minocycline. Treatment
with tetracycline or doxycycline may be used for infections that are caused
by Mycoplasma or Chlamydia. Tetracyclines have unique side effects among
antibiotics, including skin reactions to sunlight, possible burning in the
throat, and tooth discoloration. They cannot be taken by children or pregnant
women.

Aminoglycosides
Aminoglycosides (gentamicin, tobramycin, amikacin) 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.

Other Antibiotics Used Specifically for UTIs

Nitrofurantoin. Nitrofurantoin (Furadantin, Macrodantin) is an antibiotic that
is used specifically for urinary tract infections as an alternative to TMP-SMX
or a quinolone. Unlike many of the other drugs, however, it is usually taken
for 7 - 10 days, even in cases of simple cystitis. It is not useful for treating
kidney infections. Nitrofurantoin frequently causes stomach upset and
interacts with many drugs. Other chronic or serious medical conditions may
also affect its use. It should not be used in pregnant women within 1 - 2
weeks of delivery, in nursing mothers, or in those with kidney disease.

Fosfomycin. The antibiotic fosfomycin (Monurol) may be prescribed as a 1-

dose treatment for women who are pregnant.

Doripenem. Doripenem (Doribax) is a new carbapenem antibiotic, which was

approved in 2007 for the treatment of complicated urinary tract infections. It
is given by injection.

Medications for Treating Symptoms

Although antibiotics can cure for most urinary tract infections, severe
symptoms can persist for several days until treatment effectively eliminates
the bacteria. A number of options are available for relieving symptoms until
the antibiotics take action.
Phenazopyridine. Phenazopyridine (such as Pyridium, Uristat, Barodium,
Eridium, and AZO Standard) relieves pain and burning caused by the
infection. Patients should not take this medicine for more than 2 days.

Side effects include headache and stomach distress. 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, shortness of breath, and confusion. In
such cases, patients should immediately call the doctor.

Antispasm Drugs. Methenamine (such as Atrosept, Prosed, and Urised) or

flavoxate (Urispas) reduce bladder spasms, which may occur with some UTIs.
These drugs can have severe side effects, however, that the patient should
discuss with the doctor.