Do you need antibiotics for bladder infection?

If you've ever had a bladder infection, you likely remember the discomfort that came with it. A bladder infection is the most common type of urinary tract infection (UTI), and the symptoms can range from unpleasant to severe. UTI treatment typically involves taking antibiotics prescribed by a healthcare provider.

A UTI occurs when bacteria enter the bladder via the urethra, the tube through which urine leaves the body. Bacteria can come from several places, but certain factors can increase the risk of getting a UTI including structural issues in the urinary tract, poor or improper hygiene, sexual activity, and pregnancy.

When bacteria enters the bladder, the body responds the way it does to other infections, which includes swelling and irritation. The symptoms can include burning or pain when you pee, the urge to pee while only producing a few drops, foul-smelling urine, and even the loss of bladder control.

Treatment of urinary tract infections typically involves the use of antibiotics. Seeking medical attention for a UTI is important for timely treatment before your symptoms get worse. If left untreated, the infection may also continue up the urinary tract and into the kidneys. At this point, a life-threatening blood infection called sepsis is possible.

Healthcare providers will consider several factors when prescribing antibiotics for UTI. They may ask for a urine sample to identify the bacteria causing the infection. A healthcare provider will also consider the person's medical history, including allergies and past antibiotic usage, as well as anatomy. If the infection occurs in an otherwise healthy person, it may be a simple infection. A more complex infection may be the case if the person is pregnant, has an abnormal urinary anatomy, or has a history of recurrent UTIs.

Some antibiotics commonly used to treat simple UTIs include:

• Trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Sulfatrim)
• Nitrofurantoin (Macrobid, Macrodantin)
• Fosfomycin (Monurol)

Other antibiotics can be effective at treating UTIs but may not be prescribed as often. Some of these medications are not appropriate for certain people or are reserved for more complicated cases. For example, doxycycline (tetracycyline) is an antibiotic that can be used for complicated UTIs, typically those that might be found in men.

Ciprofloxacin (Cipro) is a medication that may effectively treat UTIs but can lead to serious side effects, such as tendon rupture. For this reason, this medication is usually used for more serious infections or when individuals are resistant to or are unable to tolerate the more common options.

There is a group of penicillin and penicillin-like drugs, such as amoxicillin-clavulanate (Augmentin) and cephalexin (Keflex), that can be used for UTIs, but may be avoided in some people due to risk of allergies.

Although azithromycin (Zithromax, Z-Pak) and clindamycin (Cleocin) are often used to treat other bacterial infections effectively, these medications are not considered standard of care for the treatment of a UTI.

Before prescribing an antibiotic for a UTI, your healthcare provider will likely review your medical history, including any antibiotics you have taken recently. Always follow your healthcare provider’s instructions when taking antibiotics. There are no over-the-counter antibiotics for UTI. These medicines require a prescription.

While antibiotics have to be prescribed by a healthcare provide, there are over-the-counter (OTC) medicines for UTIs, such as phenazopyridine (including Azo and Uristat) for the temporary relief of pain or discomfort while urinating. Although OTC medications may help ease symptoms of a UTI, they won’t make the infection go away. You should not take an OTC medication for a UTI without first talking to your healthcare provider.

The most important thing to do when experiencing symptoms of a UTI is to contact your healthcare provider. This will help ensure you receive the right diagnosis and treatment.

Published October 2022.