Antibiotics are the mainstay of treatment of urinary tract infection (UTI). The prognosis is good for quickly and adequately treated UTIs. Prognosis in immunosuppressed and elderly patients depends on the damage that has occurred to the urinary tract and whether there is sepsis.
Those with recurrent UTIs should be investigated further, to rule out any structural abnormalities of the urinary tract. Proper treatment of UTIs is very important because failure to do so can lead to various complications like urinary strictures, fistulas, abscesses, and damage to kidney. If very severe, it can also cause sepsis, kidney failure and death.
Treatment Of Urinary Tract Infection
Although an antibiotic can be started almost immediately upon suspicion of UTI, it is best to do a culture and sensitivity testing of urine to see which bacteria is responsible for the UTI and to which antibiotics it is susceptible, so that you can switch to the appropriate antibiotic.
The following antibiotics work in most cases of UTI, the duration of therapy being 3 to 5 days in mild UTI cases, and 7 to 14 days in severe or upper urinary tract infection cases:
(1) Trimethoprim 300 mg daily; (2) Co-amoxiclav 250 mg 8-hourly; (3) Gentamicin 3-5 mg/kg intravenous injections daily; (4) Cefuroxime 250 mg 12 hourly; (5) Ciprofloxacin 250-500 mg 12 hourly.
The full course of antibiotics has to be taken to prevent relapse. Urine culture should be repeated during the course of antibiotics, and 1 and 3 weeks after treatment, to see if the infection has resolved. Caution has to be exercised in the taking of antibiotics during pregnancy because some of them are not safe during that period.
Recurrent Urinary Tract Infection
Recurrent UTIs can be due to either relapse or reinfection. Relapse is recurrence of UTI with the same organism within 7 days of completion of antibiotic course and implies failure to eradicate infection.
This can be prevented by taking the full course of antibiotic to which the causative bacteria is susceptible. If relapse occurs, then repeat the course of antibiotic.
Reinfection is when UTI is absent after treatment for at least 14 days, followed by recurrence of infection with the same or different organism. Reinfection is not due to failure of treatment but due to susceptibility. This is treated as in any fresh case of UTI.
Prophylactic Measures For Recurrent UTI
There are some simple prophylactic measures that can be taken to prevent recurrence of UTI. A fluid intake of at least 2 liters/day is helpful. Empty the bladder regularly (3-hr intervals by day and before sleep). Empty the bladder completely.
If urinary reflux is present, you should empty the bladder, particularly before retiring for the night, a second time approximately 10-15 min after the previous passing of urine. Empty the bladder before and after sexual intercourse. Avoid constipation, as it may impair bladder emptying.
These therapies are said to not only prevent UTIs but also relieve some of the symptoms. Cranberry or blueberry juice reduces the risk of symptoms and reinfection by 12-20%, as per some studies. Its mechanism of action is by boosting your immune system to help fight bacterial growth.
Vitamin C may impede bacterial growth by increasing the acidity of urine. Other remedies with less clear mechanisms of action are pineapple, yogurt, baking soda and aromatherapy.
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