• Urinary tract infections (UTI) can be painful, debilitating and sometimes dangerous. After determining the acute severity of the infection, you and a physician may proceed through a diagnostic process to identify the offending pathogen and possible underlying causes. The treatment for a UTI consists of at least one antibacterial agent. The choice of which antibiotic to use will depend on several factors including severity of symptoms and whether the UTI is complicated or recurring. There are also drugs that can be used for temporary symptom relief while the antibiotics begin to work.

    UTI Symptoms

    While a UTI can sometimes be asymptomatic, most sufferers experience some acute symptoms. The most common symptoms include pain, discomfort or urgency during urination, and urine may contain blood (hematuria) or appear cloudy. Burning and pain (dysuria) during urination may be anywhere from mild to serious and debilitating. Sometimes only a small amount of urine may be passed at a time, even though the sensation of needing to urinate is frequent. Nausea or vomiting, side or back pain, or a fever can indicate a complicated UTI--an infection that has spread from the bladder to the kidneys or elsewhere in the body. A complicated UTI can be an emergency--failure to begin treatment can lead to kidney damage, and a system-wide infection (sepsis) that can be life-threatening. In men, UTIs are often precipitated by a blockage caused by prostatitis or a kidney or bladder stone.

    Diagnosing a UTI

    The most common method of conclusively diagnosing a UTI is through a urine analysis, which tests for blood cells and bacteria. According to the National Institutes of Health (NIH), some bacteria like chlamydia and mycoplasma cannot be detected with standard cultures--necessitating a special culture or a decision to proceed with treatment anyway. Bacteria may not always be present at the time of a urine sample if the UTI is caused by an underlying factor like prostatitis. This doesn't mean there isn't a UTI, but may mean that the UTI is a recurrent symptom of another underlying infection or health problem which will need to be diagnosed and treated.

    Treatment Strategies

    According to the Johns Hopkins University's Division of Infectious Diseases, over 95 percent of uncomplicated UTIs are caused by a single pathogen, which is usually E. coli. A combination antibiotic called Trimethoprim-Sulfamethoxazole (also called SMP-TMX and Sulfatrim) is often employed against UTIs, administered in tablet form twice daily for at least three days. Its effectiveness and dosing depends on bacterial resistance rates in your region. In areas with high E. coli resistance to SMX-TMP, other pharmaceutical options include nitrofurantoin, co-amoxiclav (Augmentin), and drugs from the powerful fluoroquinolone class of antibiotics. Nitrofurantoin usually requires seven days of treatment, as does Augmentin. Fluoroquinolones (including Cipro, Levaquin and Noroxin) were originally intended as drugs of last resort, but their use as first-line antibiotic agents against UTIs has become more frequent in recent years and has led to increased bacterial resistance. These medicines can have serious but rare side effects. If you've recently taken a fluoroquinolone drug, another treatment option should usually be found. If you have a complicated UTI, treatment with a broad-spectrum fluoroquinolone and/or intravenous (IV) antibiotic will start immediately. Urine analysis and culturing may let you switch to a narrow-spectrum drug during treatment. Treatment will usually last 10 to 14 days. Phenazopyridine (Pyridium) can be used for short-term reduction of acute painful UTI symptoms while antibiotics take effect. It has the side effect of turning one's urine exotic colors, and can stain contact lenses, and cause dizziness or stomach upset if taken without food. High urine flow accompanied by frequent urination (achieved by drinking a substantial amount of liquids) can help clear bacteria out of the urinary tract.

    The Role of Cranberry Juice

    Pure cranberry juice cannot cure a UTI. However there is some research indicating that it may be helpful in preventing UTIs, particularly in women. The mechanism of action is believed to be the proanthocyanidin chemical preventing bacterial colonies from adhering to the bladder wall. It is not yet clear if pure cranberry juice can also help shorten the duration of a UTI.


    Acute, Uncomplicated Bacterial Cystitis

    Trimethoprim + Sulfamethoxazole

    Single-dose fluoroquinolone therapy

    More Information:

    Urinary Tract Infections in Adults



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