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A lower urinary tract infection occurs when bacteria gets into the urethra and is deposited up into the bladder -- this is called
cystitis. Infections that get past the bladder and up into the kidneys are called pyelonephritis . An infection of the tube that
empties urine from the bladder to the outside is called urethritis. UTI symptoms in women and men are similar.
Upper UTIs which include the kidney may also have symptoms of fever, back pain, and nausea or vomiting.
Urinary tract infections occur more frequently in women than in men because a woman’s urethra is shorter and closer to the
anus than in men, allowing easier entry of bacteria into the urethra. Women are also more likely to get an infection after
sexual activity or when using a diaphragm for birth control. Menopause also increases the risk of a UTI.
Most patients with an uncomplicated UTI will begin treatment without any special diagnostic test, although a urinalysis may
be performed by taking a urine sample. In a urinalysis, chemical components of the urine are determined, and the doctor may
look at urine color, clarity, and a view a sample under the microscope. A urine culture may be order, too, but is not always
needed to start treatment. A urine culture can define the specific bacteria causing the UTI, in more complicated cases, or in
the case of treatment failure.
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Symptoms like burning while urinating will usually clear up in within one to two days after starting treatment. Be sure to finish
your entire course of medication. If symptoms are still present after 2 to 3 days, contact your healthcare provider
The fluoroquinolones, such as ciprofloxacin (Cipro) and levofloxacin (Levaquin) have also been commonly used for
uncomplicated cystitis; however, July 2016 FDA recommendations strongly suggest that the fluoroquinolone class be
reserved for more serious infections, and only be used if other appropriate antibiotics are not an option.
An FDA safety review found that both oral and injectable fluoroquinolones (also called "quinolones") are associated with
disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. These adverse effects can
occur soon after administration to weeks after exposure, and may potentially be permanent. Patients should discuss the use
of fluoroquinolones with their healthcare provider.
However, the oral fluoroquinolones are appropriate for more complicated UTIs, including pyelonephritis. For the outpatient
treatment of uncomplicated pyelonephritis, the following quinolones are typically be used:
In areas with fluoroquinolone resistance exceeding 10 percent, in patients with more severe pyelonephritis, those with a
complicated UTI who have allergies to fluoroquinolones, or are unable to tolerate the drug class, intravenous therapy with an
agent such as ceftriaxone, or an aminoglycoside, such as gentamicin or tobramycin, may be appropriate. Your ongoing
treatment should be based on susceptibility data received from the laboratory.
Ceftriaxone (Rocephin)
Gentamicin
Tobramycin
Vaginal yeast infections or oral thrush (candida species): Antibiotics may also change the normal flora balance in the
vagina, and lead to a fungal overgrowth. Candida albicans is a common fungus normally present in small amounts in the
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vagina and does not usually cause disease or symptoms. However, vaginal candidiasis may occur when there is limited
competition from bacteria due to antibiotic treatment.
Abdominal (stomach) upset: Antibiotics are frequently linked with stomach upset such as nausea, vomiting, lack of
appetite (anorexia), stomach pain, or heartburn (dyspepsia). Taking with food or a meal may help to decrease stomach
upset, but check with your pharmacist.
Antibiotic-associated diarrhea: Antibiotics may commonly lead to uncomplicated antibiotic-associated diarrhea or loose
stools, that will clear up after the antibiotic is stopped. Broad-spectrum antibiotics can also kill the normal gut flora
(“good bacteria) and lead to an overgrowth of infectious bacteria, such as Clostridium difficile (C. difficile). If the diarrhea
is severe, bloody, or is accompanied by stomach cramps or vomiting, a physician should be contacted to rule out C.
difficile. The most common antibiotics implicated in antibiotic-associated diarrhea are amoxicillin-clavulanate, ampicillin,
and cephalosporins, fluoroquinolones, azithromycin, and clarithromycin.
Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN): Stevens-Johnson syndrome (SJS) and toxic
epidermal necrolysis (TEN) are rare but serious allergic drug reactions. Skin reactions like rash, skin peeling, and mucous
membranes sores can occur and may be life-threatening. Antibiotics such as sulfonamides, penicillins, cephalosporins,
and fluoroquinolones may result in SJS and TEN.
High rates of antibiotic resistance are being seen with both ampicillin and amoxicillin for cystitis (E. coli), although
amoxicillin/clavulanate (Augmentin) may still be an option. Other oral treatments with reported increasing rates of resistance
include sulfamethoxazole-trimethoprim (Bactrim DS, Septra DS) and the fluoroquinolones. Resistance rates for the oral
cephalosporins and amoxicillin/clavulanate are still usually less than 10 percent.
Avycaz
Avycaz (avibactam and ceftazidime) is a next generation, non-β lactam β-lactamase inhibitor and third-generation,
antipseudomonal cephalosporin antibiotic combination for the treatment of complicated intra-abdominal infections in
combination with metronidazole and complicated urinary tract infections (UTIs), including pyelonephritis, in those who
have limited or no alternative treatment options.
Avycaz was first approved on February 25th, 2015 and is manufactured by Allergan Inc. Avycaz is given as an intravenous
infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney impairment.
Zerbaxa
Zerbaxa (ceftolozane and tazobactam) is a cephalosporin and beta-lactamase inhibitor combination for the treatment of
complicated intra-abdominal infections and used with metronidazole. Zerbaxa is also used for complicated urinary tract
infections (cUTI), including pyelonephritis.
Zerbaxa was first approved on December 19th, 2014 and is manufactured by Merck and Co. Zerbaxa is given as an
intravenous infusion every 8 hours. Dosage adjustments are required in patients with varying degrees of kidney
impairment.
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A shorter course (3 days) of antibiotics at the first sign of UTI symptoms; a prescription may be given to you to keep at
home.
A longer course of antibiotic therapy.
Take a single dose of an antibiotic after sexual intercourse.
The choice of antibiotic is based on previous UTIs, effectiveness, and patient-specific factors such as allergies and cost.
Antibiotics commonly used for recurrent UTIs can include sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor, cephalexin,
or norfloxacin.
In postmenopausal women with vaginal dryness that may be leading to recurrent UTIs, vaginal estrogen may be an effective
treatment.
Cranberry has been studied as a preventive maintenance agent for UTIs. According to one expert, the active ingredient in
cranberries -- A-type proanthocyanidins (PACs) -- is effective against UTI-causing bacteria, but is only in highly concentrated
cranberry capsules, not in cranberry juice. Cranberry seems to work by preventing bacteria from sticking to the inside of the
bladder; however, it would take a large amount of cranberry juice to prevent bacterial adhesion. In addition, cranberry was
not proven to prevent recurrent UTIs in well-controlled studies, as seen in a 2012 meta-analysis of 24 studies published by the
Cochrane database. Previous studies suggested cranberry or cranberry juice might have been useful to prevent UTIs.
The effectiveness of many herbal or home remedies may not have been scientifically tested to the same degree as
prescription medications -- or at all. Over-the-counter herbal products and dietary supplements are not regulated by the FDA.
Side effects and drug interactions may still occur with alternative treatments. Always check with your health care professional
before using an alternative treatment, herbal or dietary supplement for any condition. In most cases, an antibiotic is the best
treatment for a UTI.
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More Resources:
More Topics under Urinary Tract Infection:
Bladder Infection
Kidney Infections
Urinary Acidification
Urinary Alkalinization
Symptom Checker:
See Also
Acute Bronchitis in Adults
Alcohol and Antibiotics
Antibiotic Resistance
Antibiotic Shortages: A Serious Safety Concern
Antibiotics - Common Side Effects, Allergies and Reactions
Antibiotics and Birth Control Pill Interactions
Top 10 FAQs for Middle Ear Infections in Children
Why Don’t Antibiotics Kill Viruses?
Sources
1. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10:CD001321.
2. Hooton T, et al. Acute uncomplicated cystitis and pyelonephritis in women. Up To Date. May 26, 2016. Accessed September 19, 2016.
3. Hooton T, et al. Patient education: Urinary tract infections in adolescents and adults (Beyond the Basics). May 29, 2015. Accessed September 19, 2016 at
https://www.uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics
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