Medications

Antibiotics are the mainstay treatment for all UTIs. A variety of antibiotics are available and choices depend on many factors, including whether the infection is complicated or uncomplicated or primary or recurrent. Treatment decisions are also based on the type of patient (e.g., man or woman, a pregnant or nonpregnant woman, child, hospitalized or nonhospitalized patient, person with diabetes.) Treatment should not necessarily be based on the actual bacteria count. For example, if a woman has symptoms, even if bacterial count is low or normal, infection is probably present and antibiotic treatment should be considered.

Bacterial Resistance to Antibiotics. Of major concern for doctors and the public is the emergence of strains of common bacteria, including E. coli, that are resistant to specific antibiotics. The prevalence of such bacteria has dramatically increased worldwide, in large part due to widespread use of antibiotics in people and animal feeds.

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Resistance to antibiotics is most often observed in the hospital setting. Unfortunately, there has been a major worldwide increase within the community in E. coli resistance to standard antibiotics used for UTIs. A major study, the ECO.SENS Project, has been designed to investigate resistant UTI bacteria in 17 European countries. In a 2003 report, 42% of E. coli were resistant to one or more of the 12 antibiotics investigated. Resistance was highest to ampicillin (29.8%). Resistance to TMP-SMX (Bactrim, Cotrim, Septra) was 14.1%. (E. coli is the most common bacteria in urinary tract infections.) Resistance to other common UTI antibiotics, including mecillinam, cefadroxil, nitrofurantoin, fosfomycin, gentamicin, and ciprofloxacin still averaged under 3%. The rates vary, however, depending on regions. In general, regions and institutions with the highest rate of resistance are those in which antibiotics are heavily prescribed. In the European study, for example, resistance rates were highest in Portugal and Spain and lowest in the Nordic countries and Austria.