5 best antibiotics for UTI. Take this, not that!

What are the best antibiotics for UTI? When you are sick with a urinary tract infection, you need a quick fix and this often means a course of antibiotics for UTI.

Sometimes you are so overwhelmed with UTI symptoms, you’ll take anything that your doctor prescribes. That being said, it is better to be careful and informed about your treatment options.

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Are antibiotics necessary in your case?

Antibiotics should not be treated lightly, especially given increasing risk of patients developing antibiotic-resistant bacteria.

  • Some argue that symptoms of UTI, like burning and urge to urinate, are not always indicative of a urinary tract infection.
  • Antibiotics alone are also useless against mature bacterial biofilms.
  • Small doses of antibiotics could actually promote the growth of bacterial biofilms.
  • Molecules, available in NAC supplements can increase the effectiveness of antibiotics and help you fight mature bacterial biofilms.
  • Natural supplements like D-Mannose could be in some cases better than antibiotics

Therefore your physician should ensure that additional testing is done before prescribing antibiotics. This includes analyzing accurate local data to understand potential antibiotic-resistance in their patient population.

Accurate Diagnosing of a UTI

Can you self-diagnose a UTI? First of all, read why OTC UTI test strips could be inaccurate in your case.

Moreover, in a recent study less than 50% of women who reported to the physician with UTI symptoms, indeed had a urinary tract infection.

The most accurate factor for diagnosing UTI was the combination of urgency to urinate, burning during urination, and pyuria (the presence of white cells in a urine sample).

The same study suggests that more physicians should order wet mount microscopy test (not the same as urine dipstick test) for the presence of white cells in a urine sample prior to prescribing antibiotics for UTI.

Did you notice blood in your urine, is it cloudy or has a “funny” smell to it? These are examples of symptoms that are highly indicative of a UTI, far more predictive than lower abdomen pain and burning with urination, both of which could be attributed to bladder inflammation caused by something other than an acute infection.

Therefore, whenever you are offered antibiotics for UTI, make sure to ask for a urine culture test or wet mount microscopy test.

However, pay attention to your symptoms after an antibiotic treatment. If you just finished a course of antibiotics but your symptoms still linger, read this interview with a urologist explaining why it could be that antibiotics are not working for UTI.

Best antibiotics for UTI treatment

According to International clinical guidelines on how to treat UTI, below are the best antibiotics for UTI. I have listed them in preference order according to the guidelines.

If you do not recognize a name or two on the list, this is because some of these drugs are available in the EU, but not in the USA.

This list is only applicable for otherwise healthy and non-pregnant adults.

  1. Nitrofurantoin

    Brand names: Macrobid, Nitrofurantoin, Furadantin, Furalan, Macrodantin.

    This is my favorite antibiotic for UTI treatment because it has the least impact on gut flora. Still, if you are taking Macrobid for UTI, check out my post on pros and cons of nitrofurantoin. This antibiotic works best for UTIs caused by E. coli bacteria.

  2. Trimethoprim-sulfamethoxazole.

    Brand names: Septra, Bactrim, Sulfatrim.

    These antibiotics for UTI are becoming less popular due to increased resistance of E. coli to this medication. In some studies, more than 34% of women diagnosed with a UTI had E.coli bacteria resistant to this group of antibiotics. This means that you should only accept this antibiotic if your doctor ordered a urine culture and it showed that your bacteria are sensitive to Trimethoprim-sulfamethoxazole (Bactrim).

  3. Fosfomycin trometamol

    Brand name: Monurol.

    A single oral dose of fosfomycin trometamol, 3 g (the approved dosage), achieves high concentrations in urine. Results of recent randomized trials show that single-dose was enough to treat an uncomplicated UTI (compared to 3 to 7-day course of ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin) in women.

    This antibiotic works well for most bacteria causing UTI and has not been contributing to antibiotic resistance.

  4. Pivmecillinam

    Brand names: Alexid, Dysedin, Penomax, Melysin, Selexid, Relexid, Emcil, Pivicil.

    Pivmecillinam is an oral antibiotic with excellent clinical efficacy in the treatment of uncomplicated UTIs.

    Although Nordic countries are using this antibiotic with few problems, physicians in other countries are less familiar with it. In recent clinical studies, it was effective for infections caused by E. coli bacteria that are already resistant to other popular antibiotics, including fluoroquinolones. This antibiotic also has minimal impact on your gut’s microbiota.

  5. Fluoroquinolones, ofloxacin, ciprofloxacin, and levofloxacin.

    Brand names: Cetraxal, Cipro, Ciloxan. Update from 08/2016: read this update on Cipro from FDA.

    Even though this antibiotic is still on the list of best antibiotics for UTI, it is no longer recommended for an uncomplicated UTI due to a plethora of horrible, irreversible side effects it might cause.

    Do not accept Cipro as a prescription for an uncomplicated UTI and get familiar with dangers of using Cipro. Ask your physician for alternatives (including anything from the list above).

Note: Amoxicillin and ampicillin are considered but not recommended. Also, read about Cefdinir for UTI and why it is not included in the Top 5 best antibiotics for UTI.

Antibiotics for UTI Caused by ESBL E. coli &

Unfortunately, more and more patients are diagnosed with a UTI caused by extended-spectrum beta-lactamase (ESBL)-producing E. coli. In that case, your infection will most likely resist all first-line antibiotics listed above and there is a higher chance it develops into a kidney infection. At risk group includes:

  • Users of urinary catheters
  • Patients with recurrent UTIs
  • Patients with recent exposure to antibiotics.

Antibiotics classified as carbapenems (mipenem, meropenem, doripenem, and ertapenem) are often the drug of choice when treating UTIs caused by ESBL-producing bacteria. Antimicrobials, such as nitrofurantoin, fosfomycin, amikacin, and cefepime, may also be an option

There are also new beta-lactam/ beta-lactamase inhibitor combinations that came to the market in the United States in the past couple of years, that are effective against carbapenem-resistant Enterobacteriaceae (CRE) and multidrug-resistant Pseudomonas aeruginosa.

  • Ceftazidime-avibactam (Avycaz), active against a variety of multidrug-resistant Gram-negative bacteria, but not Gram-positive organisms.
  • Ceftolozane-tazobactam (Zerbaxa), active against a number of multidrug-resistant Gram-negative bacteria.
  • Meropenem-vaborbactam (Vabomere), for  multidrug-resistant Gram-negative bacteria.

Bacterial biofilms and antibiotics

Have you heard about bacterial biofilms? Most likely, neither you, no your doctors know about them, but bacterial biofilms could be to blame for your persistent infections and possible resistance to antibiotics.

I quote a dozen clinical studies in this post about bacterial biofilms and their interaction with antibiotics.

OTC products to supplement antibiotics for UTI

When starting with antibiotic treatment consider using D-Mannose and special probiotics to speed up recovery and prevent UTIs from recurring.

D-Mannose will help you to flush the bacteria from your bladder, while vaginal probiotics will maintain good bacteria and help to prevent future infections. Check this post if you are not familiar with D-Mannose supplement.

Which antibiotics did your physician prescribe to you? Please tell us about your experience in the comments below—and remember to let me know which country you are from.

53 thoughts on “5 best antibiotics for UTI. Take this, not that!”

  1. I have been suffering from recurring UTI’s for about 2-3 years now. Currently I am getting one a month. Every time my doctor prescribes me either Nitrofurantoin or Keflex. I have been taking d-mannose regularly for about a month now and probiotics for a few months. I have had no improvement, am incredibly concerned with how many antibiotics I’m taking, and can see no end! Any recommendations welcome

  2. Have had a uti for almost 3 weeks and cypro is not working going back to doc Monday do you think he will prescribe anything ?

    1. Hi Tendo, this is as vague question as it could be 🙂 Unfortunately, I’m not a physician and you should definitely see a doctor for a physical exam if you have problems emptying your bladder. Best wishes,

  3. I am a 77 year young woman who experiences UTI’s all the time. I see a Urogynecologist on a regular basis and have been in the past prescribed Macrobid,Septra, which I had side effects.,Cipro , Keflex.Now today I was prescribed Cefuroxime , hopefully this will help . I have been taking Botox injections for several years for severe inconvenience , which helps with that problem , however I still contend with the UTI’s.

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