Antibiotics for UTI alleviate the pain and discomfort of urinary tract infections quickly and reliably.
Every year more than six million Americans visit their doctors seeking treatment of UTIs. The overwhelming majority are women, who are 30 times more likely to suffer UTIs than men.
In nearly all confirmed UTI cases, antibiotics are prescribed and start providing relief within 24 hours. Typically, within a few days, most or all symptoms have been eliminated.
There are more than 100 different antibiotics, but not all are useful in treating a UTI. The following are the best antibiotics for UTI of 2021. Speak to your doctor to determine which one is right for you.
Amoxicillin is one of the most commonly prescribed antibiotics and is used to treat everything from bronchitis to pneumonia to ear infections, tonsillitis, and more. It also happens to be the most prescribed antibiotic for uncomplicated UTIs.
What we like: Amoxicillin is popular because, when taken as directed, it works for most simple bacterial infections. It works fast, typically produces few, if any, noticeable side effects, and is quite affordable.
Flaws: Amoxicillin is so popular it is verging on overuse.
Monural (fosfomycin) is a single dose antibiotic administered to women with uncomplicated urinary tract infections. This treatment model greatly increases compliance, speeds recovery, and reduces the chance of recurrent UTIs.
What we like: Single dose antibiotics are revolutionizing the treatment of uncomplicated urinary tract infections in women, particularly those who suffer recurrent infections. Also, dosing does not need adjusting for elderly patients.
Flaws: Most people would probably prefer the single-dose model, but it is not applicable to every case.
3. Sulfamethoxazole and trimethoprim
Although they have been in use since 1974, sulfamethoxazole and trimethoprim are not well-known outside the medical establishment. Nonetheless, they are considered one of the 100 essential medicines by the WHO.
What we like: Sulfamethoxazole and trimethoprim are effective at treating urinary tract infections in both women and men and produce few side effects for most people. The combination produces few side effects and is generally well-tolerated.
Flaws: Sulfamethoxazole and trimethoprim are prone to generating more negative drug interactions than some other antibiotics.
Commonly sold under the brand name ‘Levaquin’ levofloxacin is a member of the quinolone family of antibiotics. Levofloxacin inhibits the multiplication of bacteria by interfering with the bacteria’s ability to repair its cells.
What we like: Levofloxacin is typically given for more stubborn UTIs, or those that have displayed a resistance to other antibiotics. As such, it is a very valuable weapon in the antibacterial arsenal.
Flaws: Side effects such as lightheadedness and nausea are more common with this antibiotic than with others such as amoxicillin.
5. Cephalexin Monohydrate
Cephalexin monohydrate belongs to the cephalosporin family of antibiotics first introduced in the early 1960s. Cephalosporins are divided into five ‘generations’ with each generation indicated in the treatment of various bacteria. Cephalexin monohydrate is a first generation cephalosporin.
What we like: Like all first generation cephalosporins cephalexin monohydrate does an excellent job treating respiratory tract infections, strep throat, UTIs and more. It prevents bacteria from propagating by undermining cell wall integrity.
Flaws: Not as widely available in the US as some other antibiotics for UTI.
Ampicillin has been prescribed for bacterial infections since 1961. In that time, it has proven its safety and efficacy. It may be administered as a shot, a drip, or in capsule form. UTIs, bronchitis, meningitis, and more are all treated using ampicillin.
What we like: Ampicillin is often prescribed for pregnant women as its side effect profile is amongst the lowest. It is widely available, effective for treating UTIs, and its action is well-understood by medical professionals.
Flaws: Ampicillin carries the risk of numerous potential drug interactions.
Although most people have probably never heard of it, nitrofurantoin has been around since the early 1950s. It is prized for its mild impact on gastrointestinal flora and for its high degree of effectiveness against the E. coli bacteria.
What we like: If your UTI is a result of the E. coli bacteria, nitrofurantoin is often a good choice. Unlike a number of different antibiotics, nitrofurantoin is not likely to cause stomach distress.
Flaws: While nitrofurantoin is generally effective for most UTIs, it is not so effective for treating kidney infections.
Doxycycline is another antibiotic that is on the WHO’s list of 100 essential medicines. It is used to treat a variety of bacterial infections and is widely used in developing countries due to its relatively low production cost.
What we like: Doxycycline is typically well tolerated by most people and is easy on the side effects. It works fast and will often produce significant improvement in symptoms in less than one day.
Flaws: Doxycycline tends to make the skin more susceptible to sunburn.
Cefuroxime is a relative newcomer to the antibiotic family, having been made available for the first time in 1977. It is used to treat a rogue’s gallery of bacterial infections, including UTIs, meningitis, sepsis, and Lyme disease.
What we like: Cefuroxime is a member of the cephalosporin family of antibiotics. As a second generation cephalosporin, it is less susceptible to producing antibiotic-resistant enzymes.
Flaws: It can produce a fair number of side effects including painful intercourse, headaches, and chills.
Ciprofloxacin first entered the public consciousness during the anthrax scare of 2001. That event highlighted the ability of this antibiotic to tackle difficult bacterial adversaries. Ciprofloxacin is the newest of the widely used antibiotics for UTI.
What we like: Ciprofloxacin use is typically reserved for complex or recurring UTIs and is not recommended for patients over 60 years of age. Still, it is a valuable tool in the fight against stubborn bacterial infections and deserving of a spot on this list.
Flaws: As we said, not for patients over 60. It may also produce serious side effects such, including nerve damage and ruptured tendons.
Who Needs Antibiotics for UTI?
While the question seems like it answers itself, treatment of UTIs is not always a straightforward affair. There are different bacteria involved, infections are discovered at different points in their pathology, and different people respond to antibiotics differently. So, while anyone suffering from a UTI will probably need to consider antibiotics, which one is the right one will vary from case to case and from person to person.
How the antibiotic is administered (capsules, intravenous, etc.) will also need to be determined on a case by case basis. As will the duration of treatment. These days, single-dose antibiotic treatment may also be a viable alternative.
How We Ranked
Determining which antibiotics are best for treating urinary tract infections required long hours of research, as well as close consultation with our resident medical experts. Ranking them was perhaps even more difficult than determining which ones deserved a place on our list. That’s because different antibiotics are used to treat different types of bacterial infections.
For instance, amoxicillin may be fine for uncomplicated UTIs, but it may not be such a good choice for recurrent UTIs or UTIs produced by antibiotic-resistant microbes. As such, our rankings are determined by a combination of a particular antibiotic’s effectiveness in treating UTIs, the reputation the different antibiotics enjoy among medical professionals, and applicability.
Antibiotics for UTI are effective. The number of antibiotic-resistant UTIs is increasing (1), due mostly to people who do not finish the full course of treatment. That said, the overall success rate for antibiotics is still impressive. Few are the uncomplicated UTIs that cannot be effectively treated with some form of antibiotic.
Antibiotics for UTI are convenient. Many prescription drugs come with lists of conditions that need to be met while taking them. Not so with antibiotics for UTIs. With antibiotics, you typically take one or two capsules once or twice per day with water. The process is fast, convenient, and does not interfere with a busy lifestyle.
Antibiotics for UTI work fast. In the vast majority of cases, antibiotics will start providing relief from UTIs in one or two days. Within just a few days most UTI symptoms will be gone. It is at that point that people frequently stop taking their antibiotics. But this is a huge mistake. Stopping just because symptoms have receded is only going to increase the chances of a recurrence. And one that will be harder to deal with.
Antibiotics for UTI are affordable. When you consider the untold pain, discomfort, and long term suffering they prevent antibiotics represent an incredible healthcare value. When compared to other popular medications, antibiotics seem like a leftover from a bygone age when you did not have to go broke to fill a prescription. And with the rise of single dose antibiotics (2), that value proposition is becoming even more apparent.
Antibiotics for UTI are easy to take. Antibiotics are by far the most prescribed type of medication worldwide. And the vast majority of antibiotics are capsules people take at home with a glass of water. It is one of the simplest and easiest treatments available for potentially life-threatening conditions.
Antibiotics for UTI are safe for the vast majority of people. It is exceedingly rare for someone to have an actual allergic reaction to antibiotics. In some cases, people who report an allergic reaction are misinterpreting a normal (but no doubt unpleasant) side effect as a sign they are allergic. The fact is that for most people, antibiotics present little or no health threat when taken as directed. That said, if you have any concerns, discuss them with your doctor.
Antibiotics for UTI can help you get back to normal quickly. The early days of a UTI can be extremely unpleasant. You may have abdominal pain and pain when urinating. You may be driven to the bathroom to urinate repeatedly. You may even lose control of your bladder from time to time. Once you start your antibiotic treatment, however, you should return to a more or less normal state in just a few days.
Antibiotics for UTI are generally low in side effects. Most antibiotics (with the notable exception of the new class of fluoroquinolones) produce very mild or no side effects in most people. Compare that to cholesterol-lowering drugs that can cause liver damage (3), or even common NSAIDs that can cause kidney problems, stomach bleeding, and an increased risk of stroke (4).
Antibiotics for UTI are available as single dose treatments. Single dose antibiotics are becoming increasingly popular to deal with uncomplicated urinary tract infections (5). A single dose antibiotic is exactly what it sounds like. The patient is prescribed a single dose of a particular antibiotic – typically fosfomycin (6) – which they mix with water and drink. This further simplifies antibiotic treatment, which was already pretty simple to begin with.
Single dose antibiotics for UTI increase compliance. The biggest issue with antibiotics is a lack of compliance. That is, people often stop taking them once they start feeling better. By failing to finish the entire course, they help to create antibiotic-resistant bacteria that will be far more difficult to defeat. Single dose antibiotics have a compliance rate of close to 100%, which is helping to reduce the propagation of antibiotic-resistant bacteria.
Single dose antibiotics for UTIs reduce the chance of recurrence. Recurring urinary tract infections are an all-too-familiar phenomenon for many women (7). Single dose antibiotics, however, have proven to be effective in breaking the cycle of recurrence and are increasingly being prescribed for women with recurring UTIs.
Antibiotics for UTI may be covered by Medicare. If you are treated for a UTI while in the hospital, or you are administered intravenous antibiotics in a clinical setting, Medicare may cover the cost. If you have a Medicare Advantage Plan, it may cover the cost of antibiotics as well.
Antibiotics for UTI pose virtually no overdose threat. Many types of prescription medicine can be dangerous or downright deadly if you take too much. Fortunately, antibiotics pose virtually no overdose threat, even to children (8). This is just one of the many aspects of antibiotics that separate them from other classes of medication.
Antibiotics for UTI can save lives. Most common urinary tract infections manifest in the urethra or bladder. These can be quickly and effectively treated with antibiotics. However, if a UTI is left untreated, it can migrate to the kidneys and become a life-threatening (9). By preventing infections of the urethra or bladder (or both) from becoming kidney infections, antibiotics very literally save lives.
Q: What is a UTI?
A: A UTI, or ‘urinary tract infection’ is an infection that typically originates in the urethra (10). Most UTIs never move beyond the urethra and the bladder. Some, however, spread to the ureters that lead from the kidneys to the bladder, and perhaps even to the kidneys themselves. UTIs strike women more often than men and are almost always bacterial in nature, meaning they can be effectively treated with antibiotics.
Q: What are some symptoms of a urinary tract infection?
A: Most urinary tract infections manifest in the urethra and bladder. In those cases, symptoms may include a burning sensation when urinating, blood in the urine, pain in the lower abdomen, as well as pelvic pain in women. If the infection has spread to the kidneys, there may be nausea, vomiting, shaking, chills, a fever, and pain in the kidney area. If you believe an infection has moved to your kidneys, it is imperative you seek immediate medical assistance.
Q: How did I get a UTI?
A: A UTI is the result of bacteria entering the urinary tract. So any activity or event that brings bacteria in contact with the urethra can potentially cause a UTI. In women, that would include wiping from back to front after using the toilet. Having sex is a common cause of UTIs. Kidney stones too (11). And women with diabetes may be more susceptible because of their compromised immune system.
Q: Is a UTI the same as a bladder infection?
A: In most cases, yes. Urinary tract infections are often referred to as bladder infections and vise versa. This is because the bladder is an integral part of the urinary system, and a large number of UTIs involve the bladder. So if you believe you have a urinary tract infection and the doctor refers to it as a ‘bladder infection’, there is typically no cause for alarm. Although you may want to ask for clarification, just to be sure.
Q: What are some risk factors for UTIs?
A: The most common risk factor for UTIs is being female. Women are 30 times more likely to get UTIs than men (12). Sexual activity is also a risk factor since one can never be sure what type of bacteria another person may be hosting. Diaphragms have also been known to cause UTIs if they are not meticulously cleaned and maintained. A compromised immune system will also make it more difficult to fight off a urinary tract infection.
Q: How fast do antibiotics get rid of a UTI?
A: In the case of an uncomplicated urinary tract infection, a person can expect to start feeling relief after one or two days of antibiotic treatment. In most cases, a doctor will prescribe 10 days of antibiotics, and it is crucial that the patient fulfills the treatment regime to the letter. When a person stops taking antibiotics after a few days because they feel better, all they are doing is increasing the odds the infection will return and be harder to treat.
Q: Why do women get more UTIs than men?
A: The primary culprit is the shorter urethra (13) women have. In men, the urethra extends beyond the trunk of the body through the length of the penis. In women, the urethra ends at the vulva. As such, bacteria has a much shorter trip through the female urethra to the bladder. Pregnancy also alters the dynamics of urination for women, and this can lead to a UTI. And the presence of contraceptive devices like diaphragms also increases the risk.
Q: Why isn’t my UTI responding to antibiotics?
A: When people do not complete a prescribed course of antibiotics, remaining bacteria may adapt to the antibiotic being used and return in force. This is called antibiotic resistance, and it is a growing problem worldwide (14). The best way to ensure this does not happen to you is to take every last antibiotic capsule precisely as directed. Even if you feel like your old self after a few days, continue with the medication until it is gone.
Q: What should I do if antibiotics don’t get rid of my UTI?
A: If your UTI does not respond to antibiotics it may be resistant to the particular type of antibiotic you are using. Or you may have a viral infection (15). You will need to discuss the matter with your doctor. He or she will likely need to conduct some tests to determine exactly what type of bacteria you are dealing with. After testing, they may prescribe a different antibiotic, increase your dosage, or suggest a different course of action.
Q: Do antibiotics have side effects?
A: Most people tolerate antibiotics well. But they are known to produce some low-level side effects including constipation, headaches, and diarrhea. In extreme cases, or cases where a person has been taking antibiotics for an extended period of time, nerve damage, vomiting, and tinnitus (16) may occur.
Q: Will any antibiotic work on a UTI?
A: No. You cannot take just any antibiotic and expect it to get rid of a UTI. The body processes different antibiotics in different ways. A randomly chosen antibiotic may only pass through the urinary tract in tiny amounts that do nothing but strengthen any bacteria that may be present. Or, that it is completely ineffective against the type of bacteria in your system.
Q: Can I do anything to help the antibiotics?
A: There are a number of common sense steps you can take that will make the job of the antibiotic easier. Drinking lots of water is the #1 recommendation. This will help flush the bacteria from your system as fast as possible. Drinking cranberry juice can also help (17). In addition, avoid spicy food, alcohol, and other things that might irritate your bladder. And wear loose clothing until the infection is gone.
Q: Can antibiotics cause other problems?
A: Antibiotics can be something of a double-edged sword. They have been known to kill off friendly bacteria as well as invasive bacteria. This can sometimes lead to yeast infections, diarrhea, and other consequences. The biggest potential problem, however, is creating antibiotic-resistant bacteria by not completing the entire course of antibiotics.
Q: Is it possible to overdose on antibiotics?
A: The worst that is likely to happen if you accidentally take more of a particular antibiotic than you should is that you may develop diarrhea or an upset stomach. Beyond that, antibiotics pose little or no overdose threat.
Q: How does my doctor know which antibiotic to use?
A: Experienced MDs have pretty much seen it all. As such, they are typically able to make a quick diagnosis based on symptoms alone. But, should they be uncertain, they will order lab tests which will determine beyond a shadow of a doubt which bacteria is in play. That knowledge will drive their antibiotic recommendation.
Q: How do I know I need antibiotics for a UTI?
A: The only way to know for sure is to see your doctor. If you have symptoms such as a burning sensation when urinating, lower abdominal pain, or a strong urge to urinate frequently, you may have a UTI. If your symptoms include blood in the urine, foul-smelling urine, fever, chills, and pain in the kidney area, you should seek medical help immediately as it may indicate a more serious kidney infection.
Q: What happens if I take antibiotics too often?
A: It is up to your doctor to determine what is ‘too often’. But certainly, if you are back at the doctor’s office every month for another UTI, then you have a chronic infection situation (18), and your treatment will need to be adjusted. That may include taking a slightly smaller dose of antibiotics but for a much longer period of time.
Q: Is it possible I will need intravenous antibiotics for my UTI?
A: It depends on whether there are extenuating circumstances accompanying your UTI. If you are unable to keep food down or you have an unusually high fever, you may need to be admitted to the hospital and put on intravenous antibiotics. But such cases are the exception, and certainly not the rule. The overwhelming majority of people with UTIs can be effectively treated with antibiotic capsules at home.
Q: What are fluoroquinolones?
A: Fluoroquinolones are a relatively new class of antibiotics of which Cipro is probably the best-known. They were first introduced in the 1990s and are typically used for more intense bacterial infections such as anthrax (19). They are not generally recommended for uncomplicated urinary tract infections. But may be prescribed in certain cases. Fluoroquinolones are known to have potentially serious side effects, including nerve damage and more (20).
Q: Should I ask my doctor for fluoroquinolones to treat my UTI?
A: You can ask, but there is a good chance your doctor will respectfully decline your request. If they do turn down your request you should not feel slighted. Your doctor, whether they mention it or not, is simply following FDA guidelines that state that “fluoroquinolones should not be prescribed for… uncomplicated urinary tract infections (UTI) because the risks outweigh the benefits.”
Q: What is a single dose antibiotic?
A: Single dose antibiotic treatments have emerged in response to the dangers of overprescribed and improperly used standard antibiotics. Instead of taking an antibiotic twice a day for 10 days, the patient is given a single, large antibiotic dose that undermines the activity of the bacteria and brings an (almost) immediate halt to the infection. Many doctors are now transitioning to single dose antibiotic treatment for uncomplicated UTIs (21).
Q: When will a doctor prescribe a single dose antibiotic for UTI?
A: Single dose antibiotic treatment may be recommended if a woman has an uncomplicated UTI, a history of chronic UTIs, is sexually active, or has no other underlying conditions that might make this type of treatment ill-advised. Be aware, however, that as of this writing, not all doctors have warmed to or adopted the single dose antibiotic treatment idea.
Q: How do single dose antibiotics work?
A: Single dose antibiotics undermine the growth cycle of the infection-causing bacteria by attacking the cell walls. In addition, they prevent the bacteria from being able to stick to the inside of the urinary tract. Because the bacteria is unable to cling to the lining of the urinary tract, it is much easier to flush out, as long as the patient drinks lots of water. Because they are only taken once, single dose antibiotics also guarantee near 100% compliance.
Q: How is a single dose antibiotic taken?
A: Fosfomycin comes in powder form. You typically mix it with a half-glass of water and drink it straight away. Whether you take it with or without food makes no difference. Whether you take standard antibiotics or single dose antibiotics you will likely feel better in a few days. The difference is that you will not need to remember to take antibiotics twice a day for 10 days. This increases compliance and reduces the chance of recurrence.
Q: What if I have symptoms, but testing indicates I do not have a UTI?
A: Testing for urinary tract infections is not a flawless science. Sometimes, results can indicate no infection when symptoms indicate something very different. If you believe you have a UTI, but test results indicate otherwise, you should discuss the matter with your doctor. You also have the option of seeking a second opinion. If you have symptoms, but your tests are negative, you will need to get to the bottom of it.
Q: Does Medicare pay for antibiotics?
A: It depends almost entirely on the circumstances. If you develop a UTI while in the hospital, there is a good chance Medicare Part A will cover the cost of any antibiotics. Same if you receive antibiotics via infusion as an outpatient. But neither Part A nor Part B will cover antibiotic tablets you take at home. For that kind of coverage, you will need to sign up for a Medicare Advantage Prescription Discount Plan (22).
Antibiotics for urinary tract infections are a safe, proven, effective means of dealing with a UTI. They typically produce fast results, are low in side effects, and are very affordable when compared to most other prescription medications.
Antibiotics revolutionized the treatment of UTIs. And that revolution continues today with the introduction of single dose antibiotics and a new generation of fluoroquinolones to handle more serious infections that may not respond to other antibiotics.
The antibiotics on the above list all have solid track records when it comes to treating UTIs. Keep in mind, however, that antibiotics are not a one-size-fits-all proposition. If you believe you have a UTI, your doctor will determine which antibiotic is right for you.
For cpoe.org’s #1 recommended antibiotic for UTI, click here.