Why Are My UTI Symptoms Not Getting Better After Antibiotic Treatment?

Urinary tract infections (UTIs) can usually be treated with antibiotics, but there are times when the drugs are unable to fully clear the infection. If a UTI comes back right after taking an antibiotic, it may be due to problems with how the drugs were taken. Or it might be because the UTI is caused by a bacterial strain that's resistant to the antibiotics.

Some people also have chronic UTIs that frequently recur despite effective antibiotic therapy. Others still may be treated for a "UTI" that isn't actually a UTI.

This article looks at four different reasons why antibiotics fail in people with UTIs and what can be done to overcome these problems.

Poor Drug Adherence

If you get a UTI, your healthcare provider will prescribe a course of antibiotics to kill the bacteria that caused the infection. For the drugs to work, you need to take them every day for around two weeks.

The reason you need to do so is that the different bacteria that cause UTIs are made up of a multitude of variants (strains).

The main variants are usually fully susceptible to antibiotics prescribed, but some of the lesser variants may be partially susceptible (resistant) and harder to kill. If you stop treatment early, these harder-to-kill bacteria can begin to multiply and re-establish the infection.

Another issue is that antibiotics have short half-lives (meaning the amount of time a drug remains at an effective concentration in the bloodstream). If you skip doses or take the drugs inconsistently, the concentrations can drop to where it is less able to kill the bacteria.

Antibiotic Resistance

Antibiotic resistance occurs when a bacteria has mutated and is able to escape the effects of the antibiotic drug. One of the main reasons for this is poor drug adherence.

When you stop treatment or fail to take your antibiotics as prescribed, the otherwise small population of resistant variants can quickly multiply and become the main variant. Thereafter, the resistant variant can be passed to others through sex and other means. And, with each passing, the resistance can deepen and deepen, leading to multi-drug resistance.

People who pick up a resistant strain (referred to as acquired resistance) may find that the antibiotics prescribed to them do not work. This can happen even if they've never had a UTI before.

In such cases, your healthcare provider may repeat the treatment or prescribe a stronger antibiotic or combination of antibiotics.

Or, they may opt to perform antimicrobial susceptibility testing (AST) in which a sample of your bacteria is grown in a culture to see what types of antibiotics it is susceptible to. This can ensure you receive the most effective antibiotic or antibiotics possible.

According to a 2022 analysis from the Washington University School of Medicine, around half of 670,450 females with a UTI did not respond to the antibiotic prescribed to them. An inappropriate antibiotic was cited as one of the main reasons.

Chronic UTIs

Some people get UTIs more often than others. These chronic (persistent) infections can often return three or more times per year despite effective antibiotic treatment. The problem is that the more often a UTI recurs and is treated, the more likely it will be to develop antibiotic resistance.

Common causes of chronic UTIs include:

• Sex: During sexual intercourse, bacteria can enter the urinary tract through the opening, called the urethra, through which urine exits the body.
• Anatomy: Females are more vulnerable to UTIs because they have shorter urethras than males. Other people may have problems with the shape or function of the urinary tract that enable bacterial infection.
• Menopause: Decreased estrogen levels during menopause can cause vaginal tissues to thin, making them more vulnerable to infection. The infection can then spread to the urethra and urinary tract.
• Genetics: Some studies have shown that certain people are born with cell receptors in the urinary tract that bacteria easily stick to. These receptors commonly occur in families, suggesting a genetic link.

For people with frequently recurring UTIs, prophylactic antibiotics may be prescribed. This is when low-dose antibiotics are taken every day to help reduce your risk of getting a UTI.

When It's Not a UTI

You might feel like you have a UTI but actually have another medical condition. Even healthcare providers may sometimes assume you have a UTI based on your symptoms, only to realize that you have some other condition that does not respond to antibiotics.

Among the conditions that commonly mimic UTI are:

• Overactive bladder (OAB)
• Kidney stones
• Sexually transmitted infections like chlamydia, gonorrhea, or genital herpes
• Vaginitis
• Endometriosis
• Interstitial cystitis
• Certain cancers like bladder, kidney, prostate, penile, vaginal, or vulvar cancer
  

Summary

Antibiotics used to treat a urinary tract infection (UTI) don't always work. One of the more common reasons is the improper use of the drugs, including inconsistent dosing or stopping the treatment early.

You may also have been infected with antibiotic-resistant bacteria that are less susceptible to one or several antibiotic drugs. Other people are simply prone to recurrent UTIs due to anatomical vulnerabilities or behaviors that re-expose them to infection.

Others still may be treated for a UTI when they actually have an unrelated condition that does not respond to antibiotics.