Antibiotics For Urinary Tract Infection

Overview

Ever found yourself needing constant bathroom breaks in between important outings and suffered the symptoms of a Urinary tract infection (UTI)? 

Urinary tract infection (UTI) is an infection that can occur in any part of the urinary system, including the bladder, kidneys, ureters, and urethra, and occurs in around 50% of person AFAB at least once in their lifetime.¹ Symptomatic UTIs can either be complicated or uncomplicated. Uncomplicated UTIs are typically found in healthy persons AFAB and are caused by external pathogens while complicated UTIs are caused due to anatomical, metabolic, or functional abnormalities that tend to deactivate the natural innate host defence mechanism, leading to tissue injury.² 

It is of utmost importance to get timely and effective treatment to prevent the infection from spreading to other tissues and areas outside of the urinary tract such as the kidneys, which poses more complications. Moreover, UTIs are becoming more common and increasingly difficult to treat due to the increasing antimicrobial resistance observed especially in Gram-negative organisms.² 

Causes and symptoms of UTI

Pathogens causing UTI

As a severe public health concern, UTI is typically caused by a range of pathogens including Gram-negative and Gram-positive bacteria as well as by specific types of fungi.³

Escherichia coli is the most common cause of both uncomplicated and complicated UTIs. Uncomplicated UTI is specifically caused by Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, group B Streptococcus (GBS), Pseudomonas aeruginosa, Staphylococcus aureus, Candida spp. as well as Staphylococcus saprophyticus.³ As for complicated UTI, the common causative agents are Enterococcus spp., Klebsiella pneumoniae, Candida spp., Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and group B Streptococcus (GBS). 

Risk factors for developing UTIs

Uncomplicated UTIs are differentiated into lower UTIs (cystitis) and upper UTIs (pyelonephritis).³ Risk factors of UTI in person AFAB include a history of UTI, sexual intercourse, vaginal infection, poor hygiene, pregnancy, changes in the structure of the urinary tract, genetic susceptibility as well as lifestyle conditions such as diabetes and obesity.³

The use of a urinary catheter, immunosuppression or a weak immune system, blockage of the urinary tract, damage to nerves around the urinary bladder, personal and family history of UTI and having a condition that leads to urine flowing in the wrong way can all be risk factors of upper UTIs or pyelonephritis among individuals.⁴

Recognisable symptoms of UTIs

The most common and recognisable symptoms of cystitis or lower UTI (bladder infection) include dysuria or painful urination, increased urinary frequency and urgency, suprapubic pain, and hematuria or the presence of blood in urine.⁵ Upper UTI or pyelonephritis (kidney infection) usually shows symptoms and signs such as fever, flank pain, and costovertebral angle tenderness.⁵

Diagnosis of UTI

UTIs can be diagnosed by taking into account a combination of urinary symptoms as well as by carrying out a urine culture ⁶. It is also important to note that around 20% of those having UTI symptoms would have a negative urine culture.⁶

When an individual with symptoms of UTI visits a physician, a clinical examination is carried out to identify signs and symptoms and also evaluate the combination of the patient’s family and personal UTI history. If the symptoms and patient history suggest UTI, laboratory tests are carried out on the urine sample of the patient. These tests include urinalysis which is to analyse the appearance, concentration, and content of urine as well as a urine culture that checks if the urine consists of any infection-causing microorganisms. 

Antibiotics as the primary treatment

Antibiotics are the most common and effective treatment option against UTIs. Antibiotics either kill bacteria or prevent further bacterial reproduction and spread to alleviate the infection. There are certain criteria for selecting antibiotics for treating UTIs. 

.The selection of the right antibiotics is crucial for the treatment of UTIs and this selection should be tailored according to the results of culture and sensitivity tests.⁷

Moreover, drug resistance patterns of these microbes should also be considered as there is a high prevalence rate of drug-resistant pathogens. 

Uncomplicated UTI is usually treated with oral antibiotics while intravenous antibiotics are usually reserved for complicated UTIs. 

Commonly prescribed antibiotics for UTIs

1. Trimethoprim/Sulfamethoxazole
2. Nitrofurantoin
3. Ciprofloxacin
4. Amoxicillin/Clavulanic acid

Some antibiotics are prescribed as single agent while some are prescribed as a combination with other antibiotics. 

Dosage and duration of antibiotic therapy

Individualised and tailored treatment plans according to the urine culture to effectively eliminate UTI promptly and to prevent further complications. The dose of antibiotics to be administered depends on several factors such as:

1. Whether it is to treat or prevent a UTI
2. Patient age
3. The severity of the infection

Therefore it is important to follow your doctor’s instructions while taking antibiotics to treat a UTI. One of the most important factors to be reminded of while taking antibiotics is to complete the full course of treatment as instructed by your physician. This ensures that bacteria can be eradicated from your body. If you stop the treatment before completing the course, the remaining bacteria can continue to grow and multiply and can potentially become resistant to the antibiotics. Therefore, it is important to adjust the dosage and duration t of antibiotics according to the type and intensity of infection. 

There are certain adjustments to be made in the treatment of UTI with antibiotics in special populations such as pregnant individuals and the elderly. 3-day courses of antibiotics are safer and more effective for pregnant women while one-day courses are usually not recommended.⁸ Fluoroquinolones are not recommended in pregnancy as it is known to have teratogenic effects which is the drug’s ability to cause defects in the developing foetus.⁸ A shorter course of antibiotics is less likely to cause harm to the foetus compared to longer courses and therefore a class of antibiotics where shorter courses work effectively should be administered during pregnancy. 

UTIs are seen to be very common among the elderly population but antibiotics prescription should be done with caution as older people tend to be on various kinds of medication to treat different lifestyle and age-related diseases. A study concluded that lower UTIs can be treated with a 3-day course and a 14-day course of trimethoprim in elderly people.⁹

Potential side effects and considerations

Some people might experience some serious allergic reactions to certain antibiotics such as developing a severe skin rash, itching, hives, difficulty breathing or swallowing, and wheezing. Calling your doctor or immediately dialling 999 would advised if you are having unusual side effects or problems when taking antibiotics. 

Antibiotics can cause changes in the gut microbiota such as reduced microbial diversity, alteration of the microbiota’s functional attributes, and formation and selection of antibiotic-resistant strains which can negatively impact the host health by increasing the susceptibility to infections.¹⁰ Therefore, antibiotics must be used with caution Alternatives and Complementary Approaches

Probiotics for UTI prevention

Probiotic administration was found to reduce an individual’s susceptibility to urogenital infections and help in treating and preventing UTIs. The vaginal flora is dominated by Lactobacillus spp. and a UTI causes a shift of dominancy from this strain to pathogens associated with UTI.¹¹ Scientific studies have stated that proper regulation of the gastrointestinal microbiota and vaginal flora using the administration of probiotics could prevent urogenital infections to a great extent.¹¹ Probiotics can be taken through food such as yogurt miso, kimchi, kombucha, and certain aged cheeses, and also through commercial preparations.¹¹ 

Cranberry products and their potential role

Cranberries have a high water content of 88% and also contain vitamin C, fructose, and organic acids such as salicylate, anthocyanidins, catchins, and triterpinoids.¹² The anthocyanidins and proanthocyanidins contribute to the antimicrobial characteristic of cranberries.¹² Studies have confirmed cranberry products’ effect in preventing symptomatic UTIs in individuals with a history of recurrent UTIs.¹² Cranberry is commonly taken in the form of juice but other forms of administration such as capsules or as supplement gummies are becoming more popular.

Lifestyle modifications to prevent UTIs

There are certain simple yet effective lifestyle modifications you can adapt to prevent UTIs and maintain good urogenital health. Staying hydrated and making sure that you drink at least 8-ounce glasses of water a day would ensure that bacteria and antibiotics are flushed out of your urinary tract. Emptying your bladder often and not controlling the urge to urinate is also important. Other lifestyle changes could include regular exercise, quitting smoking, maintaining a balanced diet taking foods rich in water and antioxidants, and taking cranberry supplements. In people AFAB, the act of intercourse can let bacteria into the urethra, and therefore, urinating after sexual intercourse is crucial in preventing UTIs. 

Summary

Urinary tract infections (UTIs), can occur in any part of the urinary system, including the bladder, kidneys, ureters, and urethra It can be either complicated or uncomplicated. There are two main types of UTIs, namely lower UTI or cystitis and upper UTIs or pyelonephitis and the main causative agents of this infection are a range of both Gram-positive and Gram-negative bacteria and some types of fungi. 

To combat antibiotic resistance, it's important to use antibiotics judiciously, complete prescribed courses, and explore new treatment options. Research into alternative therapies and vaccines is ongoing. Other lifestyle changes such as staying hydrated, exercising regularly, and taking probiotics and cranberry supplements could help prevent UTIs. Research is continuously advancing in the field of UTI treatment, exploring new antibiotics, alternative therapies, and strategies for preventing infections.