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What Are The Most Common Antibiotics For Urinary Tract Infections?

Getty Images / Dmitry Vorobyev

Medically reviewed by Alex Yampolsky, PharmD

Urinary tract infections (UTIs) are bacterial infections of the urinary tract. The most common type of UTI is cystitis which occurs in the lower portion of the urinary tract when bacteria enter the urethra and travel to the bladder.

As the bacteria multiply in the urinary tract, they cause symptoms such as pain with urination, feeling like you need to urinate more frequently, feeling the need to urinate even if you've just emptied your bladder, and blood in the urine.

If you are diagnosed with a UTI, your healthcare provider will prescribe antibiotics. Antibiotics commonly recommended to treat UTIs are Macrobid (nitrofurantoin), Bactrim (trimethoprim/sulfamethoxazole), and Monurol (fosfomycin).

Fluoroquinolones like ciprofloxacin are no longer routinely recommended due to their side effects and increasing bacterial resistance.

This article will discuss the most common antibiotics used to treat UTIs, how they work, their side effects, and more.

Getty Images / Dmitry Vorobyev

Commonly Used Antibiotics for Urinary Tract Infections

UTIs are caused by bacteria and require antibiotics to treat them. These antibiotics may include:

Macrobid, Macrodantin (nitrofurantoin)

Bactrim, Bactrim DS (trimethoprim/sulfamethoxazole)

Monurol (fosfomycin)

Fluoroquinolones, such as ofloxacin, ciprofloxacin, or levofloxacin (only if other options are not suitable)

Nitrofurantoin

Nitrofurantoin is effective against most bacteria that commonly cause UTIs. There is minimal bacterial resistance to nitrofurantoin, making it a good first-line option.

If prescribed nitrofurantoin, you will typically take it for five days.

Trimethoprim/Sulfamethoxazole

Trimethoprim/sulfamethoxazole is a combination medication containing two antibiotics.

Although it can be an effective treatment for UTIs, in recent years, bacterial resistance has increased. Therefore, this drug is usually only used in areas where the resistance rate is less than 20%.

This antibiotic cannot be taken by people who are allergic to sulfa drugs. If prescribed it, you will typically take it for three days.

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Fosfomycin

Fosfomycin is another suitable antibiotic option for UTIs due to minimal bacterial resistance. However, it appears to be less effective than other standard short-course treatments.

The treatment course is just a single dose, making it a convenient option. It comes as a powder that needs to be mixed with a half-cup (3 to 4 ounces) of cool water before drinking. You do not need to take it with food.

Fluoroquinolones

Fluoroquinolones are a class of antibiotics that include ciprofloxacin, ofloxacin, and levofloxacin.

These medications should be used only if other options are not suitable. Increasing bacterial resistance to fluoroquinolones has made this class of antibiotics less useful for UTI treatment in recent years.

Complicated vs. Uncomplicated UTIs

A UTI is classified as uncomplicated when it occurs in people who are premenopausal, nonpregnant, and without urological abnormalities or co-existing health conditions. The antibiotics covered in this article apply to treating uncomplicated UTIs.

Complicated UTIs may be caused by different types of bacteria with different resistance patterns, so antibiotic treatment requires a different approach.

How Do Antibiotics Treat UTIs?

Antibiotics taken by mouth work to treat bacterial UTIs through the following steps:

The antibiotic is absorbed in the gastrointestinal tract and enters the bloodstream.

It travels in the bloodstream to the kidneys, where it is delivered to the urinary tract.

The drug is then filtered into the urine.

As the urine enters the bladder, it comes into contact with and kills the bacteria causing the infection.

Side Effects of Antibiotics

Like most antibiotics, the ones prescribed for UTIs have the potential to cause side effects.

Nausea and stomach upset are common ones that can occur with any of the three antibiotics commonly used for UTIs.

Other common side effects include the following:

Nitrofurantoin

Loss of appetite

Headache

Flatulence

Trimethoprim/sulfamethoxazole

Loss of appetite

Skin rash or redness

Fosfomycin

Diarrhea

Headache

Backache

Vaginitis

Stuffy nose

Most side effects are mild and temporary while taking antibiotics. If you experience side effects that are severe enough to consider stopping treatment, contact a healthcare provider to see if an alternative antibiotic needs to be substituted to complete therapy.

How Long Do Antibiotics Take to Treat a UTI?

Symptoms of a UTI improve rapidly after starting antibiotics, usually within a few hours. Do not stop taking antibiotics once you start to feel better, and do not save antibiotics to use later.

It can take several days to clear the infection fully, so it is important to finish the entire course of antibiotics prescribed (usually three to five days).

Contact your healthcare provider for reevaluation if you notice no improvement in symptoms after starting antibiotics or if symptoms worsen.

Preventing Antibiotic Resistance

Antibiotics work to treat an infection by killing the bacteria causing the infection. Once you start antibiotics, you should start feeling better in the first day or two. This is because the antibiotic kills bacteria and decreases your body's inflammatory response to infection.

Even though you feel better, it's important to keep taking the antibiotics until you finish the entire course. It takes time to kill all of the bacteria causing infection. Stopping antibiotics too early could cause the infection to return and lead to bacteria developing antibiotic resistance.

Resistance occurs when bacteria are exposed to an antibiotic but not completely killed. The remaining bacteria can develop a mutation that helps them survive, leading to bacteria that are harder to treat in the future.

Are There Over-the-Counter Remedies for UTIs?

There are no over-the-counter (OTC) treatments to cure a UTI, though some OTC products can help temporarily relieve the symptoms.

AZO (phenazopyridine) is a bladder anesthetic that temporarily relieves symptoms of burning, pain, urgency, and frequency but does not treat the bacterial infection.

You should always see a healthcare provider if you suspect a UTI. An untreated infection can progress up the urinary tract to evolve into a more severe infection of the kidneys (pyelonephritis).

Summary

UTIs are a common bacterial infection that requires treatment with antibiotics. The most commonly prescribed antibiotics for UTIs are nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin.

Your healthcare provider will select an appropriate antibiotic based on what they know about the most common bacteria in your local area.

Most antibiotic regimens for UTIs are one to five days in length. It is important to finish all of the prescribed antibiotics and return to see a healthcare provider if your symptoms do not improve after starting treatment.

Frequently Asked Questions

How will my healthcare provider decide which antibiotic to prescribe for a UTI?

When treating a UTI, healthcare providers select an antibiotic empirically. Empiric treatment is a best guess that accounts for the types of bacteria that commonly cause the infection and information about local antibiotic resistance patterns. They will also consider patient-specific data such as drug allergies. Sometimes collecting a urine sample for culture is part of the evaluation process, and the results of a urine culture will tell a healthcare provider if a change in antibiotic is needed. Because culture results take one to two days, they are not helpful for initial antibiotic selection.

What is the strongest antibiotic for a UTI?

The best antibiotic for an infection treats the infecting bacteria while minimally affecting the balance of healthy bacteria in the body. All of the most commonly used antibiotics kill bacteria in the urine.

Can I take antibiotics for my UTI while pregnant?

Yes, though the choice of antibiotic may differ for non-pregnant people.

Do I need to take an antibiotic to get rid of a UTI?

Yes, antibiotics are needed to clear a bacterial infection. However, there are non-infectious causes of cystitis (e.G., chemical, foreign body) symptoms, so if your symptoms do not improve after taking antibiotics, see a healthcare provider for further evaluation.

What happens if my UTI returns after antibiotic treatment?

If your symptoms return after finishing antibiotics, return to see a healthcare provider for evaluation. A urine culture will be an important part of determining whether you have an ongoing infection, need a different antibiotic, or if there is another medical problem causing your symptoms.

Madonna's Hospital Stay Highlights Risks Of Bacterial Infection

Madonna has been discharged after several days from a hospital intensive care unit and is now recovering from a "serious bacterial infection," according to her manager Guy Oseary.

The iconic singer has also postponed her world tour, named "Celebration," amid the health scare, which shines a spotlight on bacterial infections.

Madonna speaks onstage during the 65th GRAMMY Awards at Crypto.Com Arena, Feb. 5, 2023, in Los Angeles.

Kevin Winter/Getty Images for The Recording Academy

MORE: Madonna 'home and feeling better' after hospitalization for 'serious bacterial infection'

Although it isn't clear what type of bacterial infection sent Madonna to the ICU, there are different types of bacterial infections that could require medical care.

Madonna Reportedly Discharged From Hospital After Serious Bacterial Infection, Here Are Possible Causes

Madonna has reportedly had to postpone her Celebration tour after being hospitalized for "a serious ... [+] bacterial infection which led to a several day stay in the ICU." (Photo by Christopher Polk/Variety via Getty Images)

Variety via Getty Images

Three words that you don't want to hear together are "serious", "bacterial" and "infection." Those are the words that Guy Oseary, the manager for Madonna, used in an Instagram update on the 64-year-old pop singing star this past Wednesday. He had posted that Madonna had "developed a serious bacterial infection which led to a several day stay in the ICU." In this case, ICU presumably stood for intensive care unit and not Irish Chess Union. So things must have been harrowing for the star born as Madonna Louise Veronica Ciccone. But now Madonna is reportedly now "feeling better" and "resting" at home, according to what Melody Chiu wrote on June 29 for PEOPLE.

Besides what Oseary posted on Instagram, there isn't much official material from the Material Girl or her camp about what actually happened to her. It seems like Francesca Bacardi was the first to report for Page Six that Madonna had been found unresponsive, was taken to a New York City hospital, and subsequently got intubated with a breathing tube that was removed on Wednesday. At the time, Bacardi didn't cover how long the bacterial infection had been going on before Madonna had been hospitalized. On Thursday, though, TMZ indicated that Madonna had suffered from a low-grade fever for about a month but ignored her symptoms and didn't get evaluated by a doctor because she was focusing on preparing for her Celebration tour. She was supposed to begin this 84-date North American and European tour on July 15 in Vancouver, Canada.

The phrase "serious bacterial infection" is very non-specific and does not say specifically what type of bacteria had infected Madonna and where. Using this phrase is a bit like saying, "Someone did something really bad to me." There are many, many different types of bacteria out there. In fact, you are typically covered with bacteria, no matter how times you take a shower and slap yourself. Fortunately, less than one percent of all bacteria out there can cause illness in you. In fact, many bacteria are your friends and help your body perform a lot of your daily bodily functions. So remember, no matter how lonely you may feel, you are never really alone.

But troublemaking bacteria are a different story. They can enter your body in many different ways. Think about how many different openings your body has. Plus, breaks in you skin—even breaks that are too small to see—can allow bacteria to go where they are not supposed to go. That being said. Many bacterial infections don't progress to serious stages. Some resolve without treatment—such as when you get a bout of gastroenteritis after eating a piece of pizza that you found wedged in between your sofa cushions. Others can be readily treated with antibiotics—such as many bactrial infections of your skin.

Madonna's bacterial infection presumably went well past this try-some-antibiotics stage, though. Getting intubated is not something that happens every day and is done just for the fun of it. You don't typically say, "This weekend, I'm going to watch Netflix, eat some cake, and get intubated, not necessarily in that order." Intubation is when someone inserts a breathing tube—called an endotracheal tube (ETT)—through your mouth or nose down into your trachea so that oxygen can be delivered either from a bag that's pumped manually or from a machine down to your lungs.

There are really only two reasons why you should get intubated. One is if your major airways are somehow blocked or damaged to the point where air can't get through them. This can happen if you suffer some type of injury or trauma to your chest or the surrounding area. The other reason to get intubated is if you can't breathe normally on your own.

Pop icon Madonna (C), seen here performing on April 30, 2022, was reportedly found unresponsive. ... [+] (Photo by FREDY BUILES/AFP via Getty Images)

AFP via Getty Images

On the list of things that you have to do each day, breathing ranks pretty darn high. So your body has a complex system of mechanisms to ensure that you don't forget to breathe, even when looking at some avocado toast. You may lose your ability to breathe if you suffer a cardiac arrest, your respiratory muscles become exhausted, or you lose your respiratory drive in some way. Your respiratory drive results from the complex system of chemical, mechanical, behavioral, and emotional factors that keep you breathing throughout the night and day. This drive can go away if your are under anesthesia or the influence of other types of medications. You can also lose this drive when key parts of your respiratory drive system are damaged or you get very sick with something like sepsis. But more on this sepsis thing later in, oh, less than "4 Minutes."

There is certainly a range of possibilities of why Madonna may have required intubation after a serious bacteria infection had left her unresponsive. In the absence of further information, two of these possibilities seem most likely. One is that the serious bacterial infection was in her lungs—such as what happens when you have a bad pneumonia—leaving her eventually unable to effectively exchange enough oxygen and carbon dioxide in her lungs. When you can't get enough oxygen, you can end up passing out, because your body essentially says, "WTF is happening. Where the f— is the oxygen?" So, when you try to hold your breath, passing out can be a protective mechanism to force you to start breathing again.

The other leading possibility is that Madonna developed sepsis. Sepsis is when you have an infection and your immune system kind of overreacts. Although a wide range of bacterial infections can lead to sepsis, the most frequent culprits are Staphylococcus aureus, Streptococcus pyogenes, Klebsiella spp., Escherichia coli (otherwise known as E. Coli or maybe Eeeee coli), and Pseudomonas aeruginosa. Usually, your immune system is your friend, helping you fight a bacterial infection. But sometimes your immune system flips out and goes all Loki on your body's tissues and organs. This can lead to widespread inflammation all over the place and trigger all sorts of chain reactions throughout your body that can cause blood clots to form all over your body, your blood vessels to relax abnormally, and, in turn, reduced blood flow to your different organs. And your organs need blood to survive.

Typical symptoms of sepsis include changes in breathing patterns, mental status, and sweating. Now, this is when there's no obvious reason for such changes. If you are looking at a piece of cake and experiencing rapid, shallow breathing, sweating, shivering, and feeling lightheaded, then maybe it's not sepsis. On the other hand, if you are experiencing such unexplained symptoms and have been having symptoms of a urinary tract infection, pneumonia, or other infection for a while, then keep sepsis in mind and contact a medical doctor as soon as possible. This should be a real medical doctor and not someone who thinks cracking your spine is the cure to everything.

Sepsis can very quickly worsen to septic shock, which is when your blood pressure may drop precipitously. This is when you may not even be able stand up or stay awake and conscious. You may get really confused. About 30% to 40% with septic shock end up dying, according to the Mayo Clinic. The bottom line is that if someone asks you if you would like some sepsis, just say, "No" and slowly back away from the person.

Again, besides Oseary's post, there has been little official word on what's happened to Madonna. Typically, doctors don't go blabbing about what happens to their patients. So, take everything you hear with a grain of salt—but not too much salt, because too much salt can be bad for you.

One thing's clear, though. If you do have any signs of a persistent infection, such as a fever, don't ignore those signs. And don't try to treat such symptoms yourself with something like more cowbell. Instead, see a doctor. A real medical doctor.

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