How a Urinary Tract Infection Is Treated

Urinary tract infections (UTIs) are often mild and can sometimes resolve on their own with nothing more than ample fluids and maybe a mild over-the-counter (OTC) pain reliever. However, if lasting for more than two days, you may benefit from a short course of antibiotics. This is especially true if the infection has moved from your bladder to your kidneys. In instances like these, home remedies and analgesics are unlikely to provide relief and may increase your risk of complications.

Home Remedies

While antibiotics are commonly prescribed to treat a urinary tract infection, attitudes have changed in recent years due to increasing rates of antibiotic-resistant E. coli and other bacteria. Today, some doctors will take a watch-and-wait approach if a UTI is uncomplicated and has minor symptoms.

In Europe, for example, doctors will often provide a 48-hour delayed prescription to be used at the patient's discretion. Similar practices are being adopted by some doctors in the United States. However, some studies suggest that withholding antibiotics may result in a higher risk of UTI complications, and most experts have not adopted this practice.

To minimize the need for antibiotics when dealing with a minor UTI, there are a number of tried-and-true remedies to turn to:

  • Drink plenty of water. Simply by keeping the urinary tract working, you'll be able to clear out more of the circulating bacteria in the bladder or kidneys. Aim to drink no less than eight glasses of water a day (or roughly half a gallon). During an active infection, you may want to up that to as many as 16, if appropriate. The aim is to urinate and urinate often, never holding it in and going as often you need to.
  • Drink cranberry juice. Long lauded for its ability to treat UTIs, cranberry juice contains compounds thought to prevent bacteria from sticking to the walls of the urinary tract. While some scientists have publicly doubted these claims, research from Boston University School of Medicine concluded that a daily, eight-ounce glass of cranberry juice, taken over 24 weeks, reduced the recurrence of UTIs by nearly 45 percent.
  • Increase your intake of vitamin C. Vitamin C may help treat a mild urinary tract infection by increasing urine acidity and making it less accommodating to bacteria. If needed, you can bolster your intake through food with a daily supplement.

    By contrast, you should avoid any food or drink that can irritate the urinary tract and/or inflame the symptoms. This includes spicy foods, alcohol, caffeine, and citrus.

    Placing a heating pad, hot water bottle, or warm compress on your abdomen or back can help to ease the discomfort of a bladder infection.

    Over-the-Counter Therapies

    Over-the-counter drugs are mainly used to alleviate discomfort and pain of a UTI. Chief among these are nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or analgesic pain relievers like Tylenol (acetaminophen).

    Another drug, known as phenazopyridine, is designed specifically to treat urinary tract pain. It is available in lower doses without a prescription and marketed under such brand names as Azo or Uristat.

    Higher strength formulations are available by prescription and are commonly taken to reduce pain until such time as antibiotics are able to control the infection. You would need to avoid alcohol when taking phenazopyridine, as it could cause liver toxicity. Common side effects include drowsiness, increased thirst, stomach ache, fatigue, nausea, and vomiting.

    Prescriptions

    While some may be eager to get antibiotics to address their symptoms, these drugs should only be prescribed by doctors when needed (and for the shortest amount of time necessary) and used properly to reduce the risk of drug resistance.

    That said, the vast majority of UTIs are caused by bacteria and, as such, are treated with antibiotics. The choice of drug is largely dependent on whether the infection is in the bladder (cystitis) or the kidneys (pyelonephritis).

    Cystitis Treatment

    The first-line antibiotic drugs used for the treatment of uncomplicated cystitis include:

    • Trimethoprim-sulfamethoxazole (TMP-SMX)
    • Nitrofurantoin monohydrate
    • Fosfomycin

    Symptoms of cystitis will typically resolve within six days of starting treatment. Treatment may take longer if you have recurrent UTIs or have severe urinary tract symptoms. Common side effects include a headache, dizziness, stomach upset, fatigue, nausea, vomiting, itchiness, and rash.

    Nitrofurantoin and fosfomycin should be avoided if there are any signs of a kidney infection, including flank pain, fever, nausea, vomiting, and chills.

    Pyelonephritis Treatment

    Around 90 percent of acute kidney infections can be treated with oral antibiotics. The most commonly prescribed ones include:

    • Fluoroquinolones (such as ciprofloxacin and levofloxacin)
    • Cephalosporins (such as ceftriaxone)
    • Penicillin
    • Amoxicillin
    • Augmentin (amoxicillin-clavulanate potassium)

    People with milder infections may only require treatment for five to seven days. By contrast, pregnant women may require a seven- to 14-day course, while immune-compromised people may require up to 21 days of treatment. Severe cases may require a combination of intravenous (IV) and oral antibiotics.

    Fluoroquinolones are pregnancy category C drugs (meaning that they have caused birth defects in animal studies) and should not be used during pregnancy.

    Side effects of the recommended antibiotics are much the same as those used for cystitis. However, certain drugs (like penicillin) may cause a potentially life-threatening, whole-body allergy known as anaphylaxis. If left untreated, anaphylaxis can lead to shock, coma, cardiac or respiratory failure, and death.

    Complementary Medicine (CAM)

    While a number of alternative approaches have been proposed to either treat or prevent a urinary tract infection, the evidence on them to date has been lacking.

    Some, such as probiotics, have not demonstrated the same benefits to urinary tract as they have other organ systems. Others, like zinc supplements used to support UTI therapy, have been shown to increase the risk of urinary tract complications.

    Other folk remedies such as garlic, horseradish, nasturtium, and Salvia plebeia—used in traditional Chinese medicine (TCM)—have shown little to no benefit in treating or preventing UTIs in few available studies researching their use.

    As stated above, cranberry juice is an option you might consider. Cranberry supplements, typically available in caplet formulations, are also available.

    D-Mannose

    One nutritional supplement that has attracted attention in recent years is a simple sugar derived from cranberries and other plants known as D-mannose. Unlike most sugars, D-mannose does not readily enter the bloodstream and is quickly excreted from the body, unchanged, in 30 to 60 minutes.

    Because D-mannose remains unmetabolized, it does not raise blood glucose levels in the same way as other sugars. Instead, it binds to the lining of the intestinal tract and prevents bacteria from attaching to and infecting epithelial cells.

    While there is no evidence that D-mannose can treat a urinary tract infection, a 2014 study published in World Journal of Urology found that women who took D-mannose powder daily had a lower rate of UTI recurrence compared to those who took a placebo. Furthermore, the daily use of D-mannose appeared to be just as effective in preventing UTI recurrence as the daily use of the antibiotic drug nitrofurantoin.

    With that being said, D-mannose supplements can cause bloating, loose stools, and diarrhea. When taken in excessive doses, there also concerns that D-mannose may lead to kidney damage. As such, you speak with your doctor before taking this or any other OTC remedy, supplement, or herbal medication.

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