Treatment Options

Urinary tract infections (UTI) are infections that involve the bladder, urethra and kidneys. Recurrent UTIs are infections that keep happening despite treatment (they are called recurrent if a patient has more than two infections in one year or more than one infection in six months). With time, some bacteria may stop responding to an antibiotic. This is called resistance and this makes treatment more difficult.

Common signs of UTIs include the following:
  • New or worsening frequent urination
  • Foul-smelling urine
  • Burning with urination
  • Fever
  • Chills
  • Nausea
  • Flank pain (pain near the middle and lower back) 
Infections involving the kidneys can be serious and require strong antibiotics and sometimes necessitate a stay in the hospital. If admitted, the internal medicine team will administer intravenous antibiotics for a few days. Signs of kidney infections, called pyelonephritis (PIE-lo-NE-fry-TIS), include flank pain (pain below the ribs and to the sides of the body where the kidneys are located) as well as new or worsening confusion (which in older patients may occur with UTIs). 

Urinary tract infections are diagnosed by urinalysis or urine culture. Sometimes, a urinalysis (where the urine is tested and results are immediately reported) may help identify an infection. However, for patients with recurrent UTIs, it is important to know the bacteria and the antibiotics that appropriately treat it. A urine culture may take up to three days after a sample is provided. Culture results include the identification of the specific bacteria causing the infection as well as the antibiotics that treat it.

For patients with recurrent UTIs, it is important to make sure that the antibiotic used has completely cleared the UTI. To check this, a urine culture is repeated. This is called a test of cure (TOC) because it ensures that the patient has been treated. A TOC is a urine culture that is performed within 7-14 days after completing the last pill of the treatment antibiotic. 

Some patients may need to take a daily antibiotic for 6-9 months to help prevent recurrence of the infection after completing the treatment course. This is called a suppression or prophylaxis antibiotic. It is usually a low dose of an antibiotic that has minimal long-term side effects. 

It is important to have a specialist such as a urogynecologist manage recurrent UTIs so as to help avoid kidney infections and permanent kidney damage.