UTI Treatment: Antibiotics, Prevention, and When to Escalate Care

Urinary tract infections (UTIs) are common bacterial infections. Treatment depends on severity, host factors, and local resistance patterns.

Uncomplicated Cystitis (Healthy Non-Pregnant Women)

First-line (3-day courses):

• Nitrofurantoin 100 mg BID × 5 days (avoid if CrCl <30)
• Trimethoprim-sulfamethoxazole (Bactrim) DS BID × 3 days (if local resistance <20%)
• Fosfomycin 3 g single dose

Alternatives: Pivmecillinam (non-US), fluoroquinolones (reserve — collateral damage).

Complicated UTI / Pyelonephritis

• Longer courses (7–14 days), often IV→oral step-down.
• Fluoroquinolones, ceftriaxone, carbapenems per culture/sensitivity.
• Consider imaging (CT) if no improvement in 48–72 hours — abscess, obstruction.

Special Populations

• Pregnancy: Treat all bacteriuria; avoid TMP-SMX (1st/3rd trimester), fluoroquinolones, nitrofurantoin (near term).
• Men: Assume complicated; 7–14 days; evaluate for prostatitis.
• Catheter-associated: Remove/replace catheter; treat 7 days if symptomatic.
• Recurrent UTI (≥3/year or ≥2/6 months): Post-coital prophylaxis, daily low-dose antibiotics, vaginal estrogen (postmenopausal), cranberry (mixed evidence).

Prevention

• Hydration (2–3 L/day); void every 3–4 hours and post-coitus.
• Front-to-back wiping; avoid irritants (douches, spermicides).
• Vaginal estrogen for genitourinary syndrome of menopause; consider D-mannose/cranberry.

Red Flags: Seek Care

• Fever >38°C, flank pain, nausea/vomiting (pyelonephritis)
• Hematuria, new incontinence, mental status changes (elderly)
• Pregnancy, immunocompromise, known structural abnormality