As with every other section of this site, UTI treatment is complicated. We find people discuss UTI antibiotics as though this represents a single treatment option, when really, UTI antibiotics refers to a whole range of different drugs and doses.
So let’s start at the very beginning. That way you can confirm the knowledge you already have, then expand on it. There’s no point missing some of the basic building blocks when we’re aiming for complete understanding, so get reading!
Article Quick Links
- How UTI antibiotics are selected. >>>>
- Why aren’t my UTI antibiotics working? >>>>
- My UTI test results are negative, what now? >>>>
- How do I know if I have recurrent UTIs or Interstitial Cystitis? >>>>
- How does your UTI story compare to others? >>>>
We’ll do our best to present the information in easy to digest chunks, while answering the above questions.
And in the next section we’ll take a closer look at the treatment options for recurrent UTIs.
When faced with a urinary tract infection, your three main treatment options are antibiotics, natural remedies, or riding it out with nothing but water.
The longer you suffer from recurrent UTIs, the muddier these waters can seem. After all, if the treatment options you’ve tried have failed to prevent further UTIs, are any of them really working?
For many people, taking UTI antibiotics frequently is concerning, yet without having found an effective alternative, antibiotics are still their first port of call at the onset of a UTI.
Our research has shown that many females with recurrent UTIs have taken the same antibiotic for years. For some this can mean every few weeks; for others every few months.
|“My doctor just calls in a prescription for the same antibiotic to whichever pharmacy I need them at, then I collect them. When I’m overseas I stock up on cheap antibiotics if I can get them. I’ve been taking the same antibiotic at least 15 years.”|
On a basic level, frequent antibiotic use means organizing multiple prescriptions, planning ahead and spending money. But there is also serious concern around creating antibiotic-resistant superbugs, destroying your gut flora and, the one we keep coming back to – whether this type of antibiotic use even helps.
And as we mentioned in our section on What Causes UTIs, there is enough evidence to suggest that ineffective antibiotic use could be a major contributor to the formation of biofilms – chronic, embedded infections in the bladder.
Despite this, some of our interviewees say they reach a point where none of this matters enough to make them seriously reconsider their treatment. They are in pain, and they believe UTI antibiotics help ease it quickly.
Recurrent UTIs interfere with their daily lives and they rely on their antibiotics to help them get back to normal quickly.
No other solution has been offered to them, so UTI antibiotics become the only trusted weapon in a sea of remedies.
So let’s start there, with antibiotics. Hopefully we can teach you something you don’t already know.
How UTI Antibiotics Are Selected
We’ve briefly mentioned clinical and therapeutic guidelines for urinary tract infections. Along with guiding medical practitioners on how to make a diagnosis, the guidelines may help them select an appropriate treatment.
However, when it comes to choosing an antibiotic to treat any infection, there is a whole long list of things that can influence a doctor’s decision:
|“No single [antibiotic] is considered best for treating acute uncomplicated cystitis... Choosing an antibiotic depends on [its] effectiveness, risks of adverse effects, resistance rates, and… Additionally, physicians should consider cost, availability, and specific patient factors, such as allergy history.”|
When it comes down to it, without accurate test results, the choice of any antibiotic is really just an educated guess.
UTI Antibiotics Effectiveness
Currently, there is no testing method that allows a medical practitioner to find out what is causing the infection when you show up at a clinic with a UTI. They rely on their experience, your awareness of your own body and symptoms, and at times, a strip test.
If you’ve read through our testing section, you’ll know this strip test is not designed to reveal what is causing your infection – it is only supposed to be a tool to help identify whether there is an infection present. And it is a highly inaccurate tool.
So let’s recap. Your doctor can fairly accurately deduce whether you have a UTI, but at the time you show up at the clinic, three things remain unknown:
- Which bacterium or other pathogen is causing your infection (and there may be multiple)
- Which classes of antibiotic are appropriate for use on that bacterium
- How resistant that bacterium is to the different antibiotic classes
If your urine is tested, and the test is accurate (see our section on testing inaccuracy), all three of these can be answered. But this takes 2-3 days (see below for what happens then).
In the meantime, if you are prescribed an antibiotic, it can only be selected according to the following criteria:
- What type of bacteria is most likely to have caused an uncomplicated UTI, given the region you are based in
- Which antibiotic the guidelines recommended for treating that most common type of bacteria
In the US, we have a rough idea of the most common causes of UTIs. E.coli is by far the most likely known cause, and antibiotic resistance patterns are monitored in each region. This means doctors have access to information that allows them to narrow down which antibiotic is likely to be effective for a UTI caused by E.coli in their particular region.
If your doctor requests a urine sample for lab testing, it is probable they will also prescribe the first line antibiotic for your region. In doing this, they are hedging their bets.
|A first line antibiotic for a urinary tract infection is the antibiotic that is generally accepted by the medical authority of the region as being the most likely to result in successful treatment.|
The probability that the first line antibiotic will be effective is relatively high, but in the event it does not work, the lab test should* identify which antibiotic will work. In the second scenario, your doctor can then advise you to stop the first course of UTI antibiotics and switch to the antibiotic recommended by the lab.
That is all very helpful if your UTI was caused by a strain of E.coli that fits the known resistance profile, or by another pathogen that is detected using a standard urine culture test*.
If it wasn’t, isn’t, or has become a chronic, antibiotic-resistant, embedded infection, this is much less helpful.
*If you’ve read our section on testing, you’ll know this isn’t a foolproof process, and that testing can be extremely inaccurate. When a recurrent UTI has progressed to become a persistent, antibiotic-resistant, embedded infection in the bladder, even a short course of the right antibiotic will not address the underlying infection.
Adverse Effects Of UTI Antibiotics And Specific Patient Factors
If you’ve ever read the leaflet that comes with your UTI antibiotics, you will know there are many side effects that can occur with antibiotic use. Certain people react to certain antibiotics, and some antibiotics are much more likely to cause side effects than others.
Side Effects Of Common Antibiotics Recommended To Treat Uncomplicated UTI
As you’ll see below, side effects from antibiotics can get quite serious, so this is an important consideration.
|Antibiotic Class (Brand)||Duration Of Course||Possible Side Effects|
|Trimethoprim–sulfamethoxazole (Bactrim, Septra)||3 days||Fever, rash, photosensitivity, neutropenia, thrombocytopenia, anorexia, nausea and vomiting, pruritus, headache, urticaria, Stevens–Johnson syndrome, and toxic epidermal necrosis|
|Trimethoprim (Trimpex, Primsol)||3 days||Rash, pruritus, photosensitivity, exfoliative dermatitis, Stevens–Johnson syndrome, toxic epidermal necrosis, and aseptic meningitis|
|3 days||Rash, confusion, seizures, restlessness, headache, severe hypersensitivity, hypoglycemia, hyperglycemia, and Achilles tendon rupture (in patients older than 60 years)|
|Nitrofurantoin monohydrate/macrocrystals (Macrobid)||7 days||Anorexia, nausea, vomiting, hypersensitivity, peripheral neuropathy, hepatitis, hemolytic anemia, and pulmonary reactions|
|Fosfomycin tromethamine (Monurol)||Single dose||Diarrhea, nausea, vomiting, rash, and hypersensitivity|
Although one class of antibiotic may be considered the best option for a particular type of bacteria, it may also come with an increased chance of severe side effects.
In this case, your doctor may opt for an antibiotic that has a reduced chance of success but is much safer.
To help illustrate the seriousness of this, let’s look at an example. In 2016 the FDA issued a warning regarding the use of a certain class of UTI antibiotics called fluoroquinolones, advising that:
|“... the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with uncomplicated urinary tract infections who have other treatment options.”|
FDA-approved fluoroquinolones include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, norfloxacin (Noroxin), moxifloxacin (Avelox), ofloxacin and gemifloxacin (Factive) – three of which are on the list of recommended antibiotics above.
UTI Antibiotics Resistance Rates
The breakdown of causes of urinary tract infections is not the same the world over. While the same major groups of bacteria are generally identified everywhere, the percentage of infections caused by each, and the resistance of each to particular antibiotics is often different, depending on the region.
To put it simply, an antibiotic that is considered effective in one region may be considered less effective in another.
For this reason, each region has its own recommendation for first-line antibiotics when it comes to UTIs.
As we covered above, doctors use this recommendation to select which antibiotic to prescribe in the absence of conclusive test results. The recommendations change over time as bacterial resistance and prevalence changes, so medical practitioners need to keep up with the latest information.
It’s a tough job keeping up, and in reality, it is thought that up to 50% of antibiotic prescriptions in the United States continue to be unnecessary or inappropriate. This figure applies not only to UTI antibiotics, but to all prescriptions for antibiotics.
UTI Antibiotics Cost And Availability
Although one antibiotic may be considered more effective than another, it isn’t always realistic for your doctor to prescribe it. The preferred antibiotic may not be available in your region, or a high cost may outweigh the potential benefit.
Your doctor has to weigh up all these factors and make a decision on how to treat your UTI.
Without test results that clearly specify which type of pathogen is causing your infection, and how susceptible that particular pathogen is to different types of treatment, the decision is based on probability, reason and educated guesses.
This brings us, once again, back to the issue of ineffective antibiotic treatment and its possible contribution to the recurrence of urinary tract infections.
Treating a specific bacterium with an ineffective antibiotic may allow that bacterium to increase its resistance to that type of antibiotic. As the antibiotic resistance of a bacterium grows, it becomes harder to treat, and it is even more important to test for its susceptibility to future treatment options.
Given that test results take 2-3 days, your doctor must either prescribe an antibiotic without knowing what is causing your UTI, or advise you to wait until the test results come back.
When prescribing UTI antibiotics, it is crucial for a doctor to select the right antibiotic, at the right dose, for the right amount of time. For all this to be possible, they must also make the correct diagnosis. And to do that, accurate testing is essential.
Why Aren’t My UTI Antibiotics Working?
We’ve spoken a lot about UTI testing, its shortcomings, and the fact that there is currently no standard approach to testing and diagnosis of persistent recurrent UTIs.
At present, an accurate diagnosis can only be made by a specialist with expertise in the field of persistent UTI. And because treatment of these chronic conditions is also specialized, it is essential to have such a specialist oversee the entire process.
Unfortunately, the health industry is taking time to catch up to the research surrounding recurrent urinary tract conditions, and these specialists are few and far between.
Instead, many people remain in the cycle of recurrent UTIs or chronic cystitis, and never receive appropriate diagnosis or treatment.
|“I’m not even sure if the antibiotics are helping, or if it’s just because I drink a bunch of water and it flushes the UTI out. They definitely used to work, but now I think, if my UTIs keep coming back, maybe the antibiotics aren’t really working at all?”|
In an ideal situation, urinary tract infections would be easy to diagnose…
Your urine would be tested, the test would show what pathogen is causing the infection, and susceptibility testing would indicate the perfect antibiotic or other treatment for that pathogen.
Your doctor would prescribe the right treatment, your UTI would clear up, and you’d never have to think about it again. No more recurrent UTIs.
If you’ve read our testing section, you already know this is not the reality for many females. If you’re reading this site, we’re guessing there’s a good chance you also have personal experience that is quite contrary to that ideal scenario.
So let’s recap a few scenarios that could be the reason your UTI antibiotics aren’t working to eradicate your UTIs for good:
- You may not be taking the right antibiotic to treat the specific cause of your UTI
- Your UTI may not be caused by bacteria
- An embedded, antibiotic-resistant infection called a biofilm may be present in your bladder, requiring specialized, longer term treatment
In all three of these scenarios, the only way to find an answer is to get accurate testing to identify the pathogen, then find the right treatment. Unfortunately, standard testing can be very inaccurate, and you may find yourself with negative test results despite your acute symptoms.
My UTI Test Results Are Negative, What Now?
So what happens when you get tested and the test results come back negative for a UTI?
|“I could actually see blood in my urine and it was excruciating to pee. The doctor said it was obvious I had a UTI. I couldn’t believe it when my test results came back negative. All she could say was to come back in if it got worse. But then what? More tests that didn’t show anything?”|
Medical practitioners rely on test results to guide them on selecting an appropriate treatment. If your test comes back negative, but you still have symptoms, the conclusion should be that further investigation is needed, NOT that the symptoms are not indicative of an infection.
|“If a urine dipstick or lab test comes back negative but the patient is clearly describing symptoms of a UTI, doctors must listen to them. Urine tests are far from perfect and it is vital to interpret them in the context of the patient’s symptoms.”|
As we mentioned in our UTI testing section, the current standard testing methods for urinary tract infections are known to be very inaccurate.
If your UTI test is negative, it could very well be that the test is wrong.
You should be aware that it is entirely possible your doctor has no knowledge of the issues with standard testing, and may not recommend investigating further.
The guidelines medical practitioners use to guide them on testing, diagnosis and treatment do not cover the inaccuracies of current UTI testing methods.
You know your body. If you have symptoms of a UTI but your test results say otherwise, you have the right to pursue further testing. You can discuss this with your doctor if you feel comfortable doing so, and share the information you have found with them.
Alternatively, you can look into private, independent testing; or seek out a practitioner that specializes in chronic urinary tract conditions. You can find more information on these options in our better testing section.
Do I Have Recurrent UTI Or Interstitial Cystitis?
A urinary tract infection may be diagnosed based on symptoms alone or with the assistance of a dipstick strip test or a urine culture at a lab.
The diagnosis of a single UTI becomes a diagnosis of recurrent UTI once you have experienced at least three UTIs in the last 12 months or at least two within the previous 6 months.
Some females report a recurrence every time they have sex, others find it happens when they feel particularly dehydrated, or after intense exercise. And then there are the recurrences that don’t seem linked to anything except time; some individuals suffer the symptoms of an acute UTI every 4-8 weeks, like clockwork.
A diagnosis of recurrent UTIs can be indefinite. Some reports indicate that the average period of recurrence is 1-2 years. We’ve interviewed people who have been diagnosed with recurrent UTIs for more than 20.
In the absence of positive test results, many females will go on to be diagnosed with Interstitial Cystitis (IC). Depending on the knowledge of your medical practitioner and how much research you’ve done yourself, you may or may not have heard of this term.
|Interstitial Cystitis is officially defined as “An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.”|
The last part of that definition is important – it implies that IC can be diagnosed once UTI test results come back negative. That in itself is a little scary.
We know standard UTI testing methods are inaccurate, so there is a good chance a significant number of people are diagnosed with IC after receiving a false-negative on their test results. They may have an infection that testing has simply failed to pick up.
The problem with this diagnosis, is that because no common cause for IC has been found, there is also no cure.
One study published by the NIH found that 74% of females with Interstitial Cystitis had previously been diagnosed with recurrent UTI. At a certain point, when UTI tests failed to identify a bacterial cause, the diagnosis of recurrent UTI was escalated to IC for these individuals.
A number of researchers now believe many cases of Interstitial Cystitis may indeed be caused by bacteria that standard UTI testing has failed to identify.
If you have received inconclusive or negative test results, despite symptoms of a UTI, we encourage you to keep pushing for an answer. Seek better testing and find a practitioner who is willing to work with you.
One major difference we see between the diagnosis of recurrent UTI and Interstitial Cystitis is the treatment prescribed.
Females in the recurrent UTI boat are very likely to be prescribed UTI antibiotics at the onset of each acute episode, just as they would be for their first ever UTI. This happens whether or not their urine has been tested, and whether or not such testing provides a positive result.
Females diagnosed with IC, on the other hand, are not treated with antibiotics. The guidelines published by the American Urological Association in 2011 do not recommend antibiotic treatment for IC.
|“I was seeing 3 different doctors for recurrent UTIs, trying to find answers. One diagnosed me with irritable bladder or IC. The other two were still prescribing antibiotics. I had no idea what to do.”|
Given that almost three quarters of females diagnosed with IC were first diagnosed with recurrent UTIs, and that the diagnosis can literally change overnight, there is something obviously wrong here.
One or both of these groups are not receiving appropriate treatment. And it would seem that neither group has access to accurate testing.
How Does Your UTI Story Compare?
We’ve been chatting to females with recurrent UTIs for a few years now, and they’ve helped us map out their treatment experiences. It looks a little something like this – maybe you can find your own story in the flow.
At any point shown in pink, individuals tend to either re-enter the loop, or resort to figuring things out on their own. Often this means managing or ‘dealing with’ UTIs as they occur, without visiting any further practitioners.
Although we mentioned that females with recurrent UTIs may eventually be given a diagnosis of IC, you may notice that it doesn’t appear in this flow.
Most of our interviewees indicated they have not received conclusive test results, or are not sure if their urine has ever been tested in a lab.
Yet, they have not received a diagnosis of interstitial cystitis despite remaining in the cycle of recurrent UTIs – some for more than 20 years. They have lived with their own sets of chronic symptoms for years, and their experiences are as unique as they are alike.
However, if we go back to the definition of IC and compare their personal stories, it is possible many would fit the criteria… And in fact, some people have self-diagnosed IC, believing that their symptoms, lack of positive test results, and the duration of their suffering fit the description.
|“My first test was negative so I thought I might have had Interstitial Cystitis. But then I had different testing and found out there were bacteria, so I thought it must be another UTI and I just have to try these antibiotics.”|
Listening to these experiences, it has become clear that many of us are often unwilling to just accept the diagnosis we receive and instead search online to find a more permanent solution.
When their own research fails to resolve the issue, regardless of whether they believe they have recurrent UTI or IC, they rely on their doctors to guide them, but their doctors rarely have the knowledge to help them find a solution.
Why is this?
Although recurrent UTIs are prevalent, and the number of diagnoses of IC is rising, research is taking time to catch up. What research we do have indicates that these long term urinary tract infections are likely caused by bacteria that form biofilms within the bladder.
Biofilms form when bacteria attach themselves to the bladder wall, or embed within the cells of the bladder lining, and form communities that are well protected from antibiotics and the body’s natural defence mechanisms.
While the existence of antibiotic-resistant biofilms in human infections has been known for years (dental plaque, kidney stones and stomach ulcers are extremely common examples of this), research into their role in urinary tract infections has only recently picked up speed. And it is not yet accepted in mainstream medicine.
There are many unanswered questions and differing opinions, leaving sufferers in the limbo of mixed diagnoses and ineffective treatment. And there are very few medical practitioners actively treating the issue (read our UTI Treatment section for more on this).
One thing we hope everyone can agree on – this has to change.
Share your questions and comments below, or get in touch with our team.