UTI Treatment: A Nephrologist’s Guide.

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The Short Answer:

UTI treatment depends mainly on antibiotics according to culture and sensitivity testing. Other treatments include Phenazopyridine, good hydration, etc.

Quick Insights:

The main UTI treatment is a proper antibiotic that eliminates the causative bacteria.
Commonly used antiotics for UTI include Nitrofurantoin, Trimethoprim-Sulfmethaxazole, and Fosfomycin.

Urinary pain analgesics are also important in severe symptoms including Phenazopyridine, ibuprofen and others.
Good hydration.
Frequent emptying of the urinary bladder.

And other remedies and life style changes that help preventing recurrent UTIs.

[1] Antibiotics: The MAIN UTI treatment.

Antibiotics is the main of UTI treatments:

Urinary tract infections are caused by bacteria invading your urinary bladder (mainly E. Coli bacteria).

UTI treatment is based on medications that kill the causative bacteria (antibiotics).

No other treatments are as effective as or can replace antibiotics for UTI treatment. Moreover, Starting an antibiotics will help you get rid of UTI symptoms fast (within 24 hours).

Although some UTIs may go away independently, Antibiotics will remain the mainstay of treatment.

What type of antibiotic should you take for UTI:

General rules for taking antibiotics for UTI:

Simple UTI (cystitis) will often need antibiotics.
Antibiotics are prescription drugs, meaning you shouldn’t take them without medical supervision.
Complicated UTIs (kidney or systemic infections) typically need intravenous antibiotics (injections).

Patients with simple cystitis without risks of antibiotics resistance can be treated without culture and sensitivity tests with one of the following:
- Nitrofurantoin (Macrobid®).
- Trimethoprim-Sulfamethoxazole (Septra®) or trimethoprim alone.
- Fosphomycin (Monurol®).
- Pivmecillinam (Not available in the USA).
Patients with suspected antibiotic resistance or complicated UTIs may need more powerful antibiotics.

Common First-line antibiotics (can be administered without culture and sensitivity testing in simple UTI) (reference):

ANTIBIOTIC	DOSE	DURATION
Nitrofurantoin (Macrobid®)	100 mg Tablets twice daily	Five days.
Trimethoprim-Sulfamethaxal (Septra®).	160/800 mg Twice daily	Three days
Fosfomycin (Monurol®)	3 g oral tablets.	Single dose
Trimethoprim (for patients with Sulfa allergy)	100 mg oral tablets twice daily	Three days.
Pivmecillinam (Not available in the USA).	400 mg tablets three times daily	3-5 days.

Other options of antibiotics that your doctor can prescribe:

Ciprofloxacin.

Amoxacillin-clavulanate.
Cefpodoxime.
Cefdinir.

Cefadroxil.
Cephalexin.
Levofloxacin.

Culture and sensitivity testing is typically done if there is a risk of resistance. This test usually reveals the exact causative bacteria and the best antibiotic for UTI treatment.

How long does it take for antibiotics to work for UTI?

Antibiotics often takes 3 to 5 days to kill the bacteria causing UTI. However, you may feel partial relief from the UTI symptoms, such as burning micturition, within a few hours after taking the antibiotics (reference).

[2] UTI Pain treatment: Phenazopyrine and other analgesics.

Bladder pain and burning urine are the main symptoms in patients with UTI. the burning pee and pelvic pain can be severe and annoying to many women.

The treatment of pain and burning sensation relays mainly on the following:

Starting the appropriate antibiotic: antibiotics will work within hours to relieve the symptoms of UTI (including UTI and burning urination) (reference).
Phenazopyridine: Phenazopyridine is an over-the-counter (Pyridium® or Azo Urinary Pain Relief®) medication that is used to relieve the pain, burning, and discomfort associated with UTI. It is usually given as an extra medication to antibiotics, and it should be taken for a few days after the UTI symptoms are gone.

Analgesics: Over-the-counter analgesics such as ibuprofen (400 mg three times per day) and acetaminophen can also relieve the pain associated with UTI.
Hydration: Drinking plenty of water and other fluids can help flush out bacteria from the urinary tract and reduce the symptoms of UTI.
Avoiding irritants: Irritants such as bubble baths, spermicides, and certain soaps may also help prevent UTIs.

Heating Pad: you can apply a heating pad over the bladder if the pain is severe.

[3] Good hydration.

Concentrated urine causes more irritation to the inflamed bladder and urethral walls. Getting enough water will wash out irritant substances from the urinary bladder.

Although over-hydration will make you pee more frequently, the soothing effect on the urinary bladder will overcome its side effects.

Drink at least 12 cups (8-Oz cups) per day (about three liters per day.

[4] Keep your bladder empty.

During a urinary tract infection, the bladder wall is inflamed and very sensitive to pain and distension.

That’s why you frequently feel pain and a sudden urge to pee when the amount of urine stored in the bladder increases.

Frequent emptying of the urinary bladder will help you become more comfortable and ease irritation (at least partially).

Also, you should incorporate water and good hydration into your daily lifestyle after the attack of UTI. Good hydration is proven to decrease the recurrence of UTIs.

[5] Recurrent UTI Prevention & remedies.

UTIs are very common among women due to several factors, the The anatomy of their urethra and its opening in a moist area near the vaginal and anal openings makes women more vulnerable to UTIs.

Studies estimates recurrent UTI is common among women (even among young and healthy women). More than 25% of the women will have recurrent UTI (cystitis) within six months from the previous episodes.

Risk factors include:

Behavioral risk factors.
- Being sexually active (the frequency of sexual intercourse is the strongest risk factor for recurrent cystitis (reference)).
- New sex partners.
- Diaphragm-spermicide use.
- Spermicide-coated condoms.
- Having the first UTI before or at the age of 15 years.
- Having a mother with a history of UTIs.

Abnormal Urinary tract (especially in postmenopausal women).
- Urinary incontinence.
- Cystocele (dropped or prolapsed urinary bladder into the vaginal space).
- Post-voiding residual urine (incomplete voiding of the urinary bladder).
Genetic or biological factors.
- Genetic predisposition to recurrent UTIs is obvious. For example, daughters of women with recurrent UTIs are at higher risk.

Effective Remedies to prevent recurrent UTIs:

Increase the amount of water intake to at least 2-3 liters per day.
Avoid the use of spermicides and spermicide-coated diaphragms and condoms.

Pee (empty your bladder) immediately after intercourse.
Wipe from front to back to minimize the infections from the bowel bacteria.
Topical (vaginal) estrogen if you are postmenopausal.

Methamine (Hiprex®): it is an anti-infective antibiotics medication (prescription-only). It is usually used for long periods (one tablet, twice daily) to prevent the recurrence of UTIs.
Cranberry (pills, juice, or dried forms): cranberry may help prevent recurrent UTIs (but it doesn’t treat already existing UTIs).
D-Mannose: a natural sugar (available as OTC) that can prevent recurrent cystitis (Bladder UTI).

Probiotics: beneficial living bacteria that may help prevent recurrent UTIs. Lactobacillus probiotics are the most commonly used type of bacteria.
Good control of your blood sugar levels (if you are diabetic).
Vitamin C: boosts the immune system and helps your fight bacteria.

Prophylactic antibiotics: in special cases, continuous or postcoital prophylactic antibiotics may be prescribed by your doctor to prevent recurrent UTIs. The types doses does of prophylactic antibiotics are in the table below (reference),

Evidence-based

Written by a doctor.

MD, Internal Medicine and Nephrology specialist.

Dr. Esraa A. MagidAuthor

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