What You Need to Know About Resistant Urinary Tract Infections

Urinary tract infections, or U.T.I.s, are one of the world’s most common infections. Increasingly, they also are resistant to major drug treatments. Here’s what you should know.

What is a drug-resistant urinary tract infection?

In the case of a resistant U.T.I., one or more standard antibiotics no longer work to cure the infection, but the bacteria is generally not resistant to all drugs.

What can I do to avoid getting a U.T.I. in the first place?

Women are more susceptible to U.T.I.s, as they are commonly known, owing to the way these germs infect: They often travel through fecal residue from the rectum to the urethra; this can happen through sex or poor bathroom hygiene. Even taking great care does not make them entirely avoidable.

Here are some steps that can help prevent urinary tract infections: Drink plenty of fluids, which helps flush out the bladder. Empty your bladder after sexual intercourse. Practice good bathroom hygiene, which, simply put, means wiping from front to back.

During the reproductive years, women are as much as 50 times more likely than men to get a U.T.I. However, those numbers even out significantly in an aging population because men wind up getting surgical procedures, or have bowel control issues, that might lead to the same spread of germs from gut and rectum to the urinary tract.

How often are U.T.I.s resistant?

The majority of urinary tract infections are now resistant to one or more antibiotics. The drug ampicillin, once a common treatment, has been largely abandoned because most U.T.I.s are now resistant to it.

The most important question isn’t whether an infection is resistant to any drug, but whether it is resistant to the drugs that are commonly used to treat your particular infection.

When experts in the field think about resistant U.T.I.s, they say that resistance “depends on the bug and the drug.” What that means is that they try to figure out which particular germs are resistant to specific medications.

What drugs work?

The drugs that are used to treat urinary tract infections have changed over the years, in large part because of rising resistance. Currently, there are a few “front-line” drugs that are recommended by various expert organizations, such as the Infectious Disease Society of America.

Two drugs that are the most highly recommended for uncomplicated U.T.I.s are nitrofurantoin, sold as Macrobid, and trimethoprim-sulfamethoxazole, sold as Bactrim or Septra. Both require a prescription, with doses and time courses that vary with the medication. But there has been growing resistance to Bactrim.

Nitrofurantoin seems to be more effective. Urinary tract infections caused by E. coli were susceptible to it 96 percent of the time, the New York City health department found. But the nitrofurantoin tends not to work in more advanced U.T.I.s where the infection reaches the kidneys, a condition known as pyelonephritis.

An older drug called fosfomycin has been revived as an alternative, but it is considered less effective than either nitrofurantoin or Bactrim. Other second-tier treatments tend to have either side effects or higher resistance rates.

What about other remedies, like cranberry juice?

Science doesn’t back up the healing power of such remedies. However, they might appear to work because many U.T.I.s will clear up over a few days as the body fights them off. In other cases, the symptoms may, in fact, be caused by another ailment that goes away on its own.

How do I know if my particular strain of U.T.I. is resistant to a particular drug?

The only way is to get a urine culture. The lab results will identify the germ and what would be effective in treating the infection. But it can take several days to get the results.

Most patients want an immediate prescription so doctors usually make a best-guess determination of what drug will work given a patient’s symptoms and history.

The importance of “history” cannot be overstated; if you have had a previous U.T.I., a previous resistant U.T.I., or have traveled outside the country, your history can help a doctor decide which drug to use.

Increasingly, experts tell us that you should ask for a culture when you go in for a U.T.I. treatment, even if you get an immediate prescription. The culture will allow a doctor to change the drug if the first one does not work.

That said, there is an important catch about when to do a urine culture. Often, it will show bacteria in the bladder even when an infection is not present. Some amount of bacteria is normal. The Infection Disease Society of America cautions doctors against doing cultures when symptoms of a U.T.I. are not present. The culture likely presence of bacteria can then lead to prescription of unnecessary antibiotics, contributing to the rise of resistance through overuse of the drugs.

Finally, some U.T.I.s, even when there are symptoms, can clear up on their own. This is one of many reasons to seek the care of an informed professional.

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Matt Richtel is a best-selling author and Pulitzer Prize-winning reporter based in San Francisco. He joined The Times staff in 2000, and his work has focused on science, technology, business and narrative-driven storytelling around these issues.

  @mrichtel

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