Editing Urinary tract infection (section)

==Treatment==
The mainstay of treatment is [[antibiotic]]s. [[Phenazopyridine]] is occasionally prescribed during the first few days in addition to antibiotics to help with the burning and urgency sometimes felt during a bladder infection.<ref>{{cite journal | vauthors = Gaines KK | title = Phenazopyridine hydrochloride: the use and abuse of an old standby for UTI | journal = Urologic Nursing | volume = 24 | issue = 3 | pages = 207–209 | date = June 2004 | pmid = 15311491 }}</ref> However, it is not routinely recommended due to safety concerns with its use, specifically an elevated risk of [[methemoglobinemia]] (higher than normal level of [[methemoglobin]] in the blood).<ref>{{cite book| veditors = Aronson JK |title=Meyler's side effects of analgesics and anti-inflammatory drugs|year=2008|publisher=Elsevier Science|location=Amsterdam|isbn=978-0-444-53273-2|page=219|url=https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|url-status=live|archive-url=https://web.archive.org/web/20160507143221/https://books.google.com/books?id=2WxotnWiiWkC&pg=PA219|archive-date=7 May 2016}}</ref> [[Paracetamol]] may be used for fevers.<ref>{{cite book| vauthors = Cash JC, Glass CA |title=Family practice guidelines|year=2010|publisher=Springer|location=New York|isbn=978-0-8261-1812-7|page=271|url=https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|edition=2nd|url-status=live|archive-url=https://web.archive.org/web/20160611013523/https://books.google.com/books?id=4uKsZZ4BoRUC&pg=PA271|archive-date=11 June 2016}}</ref> There is no good evidence for the use of cranberry products for treating current infections.<ref>{{cite journal | vauthors = Santillo VM, Lowe FC | title = Cranberry juice for the prevention and treatment of urinary tract infections | journal = Drugs of Today | volume = 43 | issue = 1 | pages = 47–54 | date = January 2007 | pmid = 17315052 | doi = 10.1358/dot.2007.43.1.1032055 }}</ref><ref>{{cite journal | vauthors = Guay DR | title = Cranberry and urinary tract infections | journal = Drugs | volume = 69 | issue = 7 | pages = 775–807 | year = 2009 | pmid = 19441868 | doi = 10.2165/00003495-200969070-00002 | s2cid = 26916844 }}</ref>

[[Fosfomycin]] can be used as an effective treatment for both UTIs and complicated UTIs including acute pyelonephritis.<ref name="Zhanel Zhanel Karlowsky 2020 pp. 1–11" /> The standard regimen for complicated UTIs is an oral 3g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form.<ref name="Zhanel Zhanel Karlowsky 2020 pp. 1–11">{{cite journal | vauthors = Zhanel GG, Zhanel MA, Karlowsky JA | title = Oral and Intravenous Fosfomycin for the Treatment of Complicated Urinary Tract Infections | journal = The Canadian Journal of Infectious Diseases & Medical Microbiology | volume = 2020 | pages = 8513405 | date = 28 March 2020 | pmid = 32300381 | pmc = 7142339 | doi = 10.1155/2020/8513405 | publisher = Hindawi Limited | doi-access = free }}</ref>

[[Gepotidacin]] was approved for medical use in the United States in March 2025.<ref name="GSK PR 20250325">{{cite press release | title=Blujepa (gepotidacin) approved by US FDA for treatment of uncomplicated urinary tract infections (uUTIs) in female adults and pediatric patients 12 years of age and older | website=GSK | date=25 March 2025 | url=https://us.gsk.com/en-us/media/press-releases/blujepa-gepotidacin-approved-by-us-fda-for-treatment-of-uncomplicated-urinary-tract-infections-uutis-in-female-adults-and-pediatric-patients-12-years-of-age-and-older/ | access-date=28 March 2025}}</ref> It is the first new antibiotic approved in the US for UTIs in nearly 30 years.<ref>{{Cite web |date=25 March 2025 |title=FDA approves first new antibiotic for UTIs in nearly 30 years |url=https://www.nbcnews.com/health/health-news/fda-approves-first-new-antibiotic-utis-nearly-30-years-rcna197953 |access-date=26 March 2025 |website=NBC News }}</ref><ref>{{Cite web |last=Goodman |first=Brenda |date=25 March 2025 |title=Millions of women get painful UTIs that keep coming back. A new kind of antibiotic may help break the cycle |url=https://www.cnn.com/2025/03/25/health/uti-antibiotic-fda-gepotidacin-blujepa/index.html |access-date=26 March 2025 |website=CNN }}</ref>

===Uncomplicated===
Uncomplicated infections can be diagnosed and treated based on symptoms alone.<ref name="Review08" /> Antibiotics taken by mouth such as trimethoprim/sulfamethoxazole, nitrofurantoin, or [[fosfomycin]] are typically first line.<ref>{{cite journal | vauthors = Grigoryan L, Trautner BW, Gupta K | title = Diagnosis and management of urinary tract infections in the outpatient setting: a review | journal = JAMA | volume = 312 | issue = 16 | pages = 1677–1684 | date = 22 October 2014 | pmid = 25335150 | doi = 10.1001/jama.2014.12842 }}</ref> [[Cephalosporin]]s, [[amoxicillin/clavulanic acid]], or a [[Quinolone antibiotic|fluoroquinolone]] may also be used.<ref name="Cochrane10" /> However, [[antibiotic resistance]] to fluoroquinolones among the bacteria that cause urinary infections has been increasing.<ref name="Detweiler2015" /> The [[Food and Drug Administration]] (FDA) recommends against the use of fluoroquinolones, including a [[Boxed warning|Boxed Warning]], when other options are available due to higher risks of serious side effects, such as [[tendinitis]], [[tendon rupture]] and worsening of [[myasthenia gravis]].<ref>{{cite web | title = FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects | url = https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | website = [[Food and Drug Administration]] (FDA) | access-date = 17 July 2019 | date = 8 March 2018 | url-status = live | archive-url = https://web.archive.org/web/20190718015612/https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics | archive-date = 18 July 2019 }}</ref> These medications substantially shorten the time to recovery with all being equally effective.<ref name="Cochrane10">{{cite journal | vauthors = Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L | title = Antimicrobial agents for treating uncomplicated urinary tract infection in women | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD007182 | date = October 2010 | pmid = 20927755 | doi = 10.1002/14651858.CD007182.pub2 | veditors = Zalmanovici Trestioreanu A  }}</ref><ref>{{cite journal| vauthors = Jarvis TR, Chan L, Gottlieb T |title=Assessment and management of lower urinary tract infection in adults|journal=Australian Prescriber|date=February 2014|volume=37|issue=1|pages=7–9|doi=10.18773/austprescr.2014.002|doi-access=free}}</ref> A three-day treatment with trimethoprim/sulfamethoxazole, or a fluoroquinolone is usually sufficient, whereas nitrofurantoin requires 5–7{{nbsp}}days.<ref name="Review08" /><ref name="IDSA2010" /> Fosfomycin may be used as a single dose but is not as effective.<ref name="Detweiler2015" />

Fluoroquinolones are not recommended as a first treatment.<ref name="Detweiler2015" /><ref name="AUSFive">{{Citation |author1 = American Urogynecologic Society |author1-link = American Urogynecologic Society |date = 5 May 2015 |title = Five Things Physicians and Patients Should Question |publisher = American Urogynecologic Society |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/societies/american-urogynecologic-society/ |access-date = 1 June 2015 |url-status = live |archive-url = https://web.archive.org/web/20150602021428/http://www.choosingwisely.org/societies/american-urogynecologic-society/ |archive-date = 2 June 2015 }}</ref> The [[Infectious Diseases Society of America]] states this due to the concern of generating resistance to this class of medication.<ref name="IDSA2010">{{cite journal | vauthors = Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE | title = International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases | journal = Clinical Infectious Diseases | volume = 52 | issue = 5 | pages = e103–e120 | date = March 2011 | pmid = 21292654 | doi = 10.1093/cid/ciq257 | doi-access = free }}</ref> [[Amoxicillin-clavulanate]] appears less effective than other options.<ref>{{cite journal | vauthors = Knottnerus BJ, Grigoryan L, Geerlings SE, Moll van Charante EP, Verheij TJ, Kessels AG, ter Riet G | title = Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials | journal = Family Practice | volume = 29 | issue = 6 | pages = 659–670 | date = December 2012 | pmid = 22516128 | doi = 10.1093/fampra/cms029 | doi-access = free }}</ref> Despite this precaution, some resistance has developed to all of these medications related to their widespread use.<ref name="Review08" /> Trimethoprim alone is deemed to be equivalent to trimethoprim/sulfamethoxazole in some countries.<ref name="IDSA2010" /> For simple UTIs, children often respond to a three-day course of antibiotics.<ref>{{cite web|url=http://www.bestbets.org/bets/bet.php?id=939| vauthors = Afzalnia S |date=15 December 2006|title=BestBets: Is a short course of antibiotics better than a long course in the treatment of UTI in children|website=www.bestbets.org|url-status=live|archive-url=https://web.archive.org/web/20090814225657/http://www.bestbets.org/bets/bet.php?id=939|archive-date=14 August 2009}}</ref> Women with recurrent simple UTIs are over 90% accurate in identifying new infections.<ref name="Review08" /> They may benefit from self-treatment upon occurrence of symptoms with medical follow-up only if the initial treatment fails.<ref name="Review08" />

The combination [[sulopenem etzadroxil/probenecid]] (Orlynvah) was approved for medical use in the United States in October 2024.<ref name="FDA Orlynvah">{{cite web | title=FDA approves new treatment for women with uncomplicated UTIs | website=U.S. [[Food and Drug Administration]] (FDA) | date=1 October 2024 | url=https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-treatment-uncomplicated-urinary-tract-infections-adult-women-who-have-limited-or-no | access-date=25 October 2024}}</ref><ref>{{cite press release | title=Iterum Therapeutics Receives U.S. FDA Approval of Orlynvah (Oral Sulopenem) for the Treatment of Uncomplicated Urinary Tract Infections | website=Iterum Therapeutics | date=25 October 2024 | url=https://ir.iterumtx.com/press-releases/detail/136/iterum-therapeutics-receives-u-s-fda-approval-of | access-date=25 October 2024}}</ref>

===Complicated===
Complicated UTIs are more difficult to treat and usually requires more aggressive evaluation, treatment, and follow-up.<ref name="Bryan2002">{{cite book | vauthors = Bryan CS |title=Infectious diseases in primary care |publisher=W.B. Saunders |location=Philadelphia |year=2002 |pages=319 |isbn=978-0-7216-9056-8 |url=http://pathmicro.med.sc.edu/infectious%20disease/Urinary%20Tract%20Infections.htm |url-status=live |archive-url=https://web.archive.org/web/20120213052452/http://pathmicro.med.sc.edu/Infectious%20Disease/Urinary%20Tract%20Infections.htm |archive-date=13 February 2012 }}</ref> It may require identifying and addressing the underlying complication.<ref>{{cite journal | vauthors = Wagenlehner FM, Vahlensieck W, Bauer HW, Weidner W, Piechota HJ, Naber KG | title = Prevention of recurrent urinary tract infections | journal = Minerva Urologica e Nefrologica | volume = 65 | issue = 1 | pages = 9–20 | date = March 2013 | pmid = 23538307 }}</ref> Increasing antibiotic resistance is causing concern about the future of treating those with complicated and recurrent UTI.<ref name="Pallett-2010">{{cite journal | vauthors = Pallett A, Hand K | title = Complicated urinary tract infections: practical solutions for the treatment of multiresistant Gram-negative bacteria | journal = The Journal of Antimicrobial Chemotherapy | volume = 65 | issue = Suppl 3 | pages = iii25–iii33 | date = November 2010 | pmid = 20876625 | doi = 10.1093/jac/dkq298 | doi-access = free }}</ref><ref name="Shepherd-2013">{{cite journal | vauthors = Shepherd AK, Pottinger PS | title = Management of urinary tract infections in the era of increasing antimicrobial resistance | journal = The Medical Clinics of North America | volume = 97 | issue = 4 | pages = 737–57, xii | date = July 2013 | pmid = 23809723 | doi = 10.1016/j.mcna.2013.03.006 }}</ref><ref>{{cite journal | vauthors = Karlović K, Nikolić J, Arapović J | title = Ceftriaxone treatment of complicated urinary tract infections as a risk factor for enterococcal re-infection and prolonged hospitalization: A 6-year retrospective study | journal = Bosnian Journal of Basic Medical Sciences | volume = 18 | issue = 4 | pages = 361–366 | date = November 2018 | pmid = 29750894 | pmc = 6252101 | doi = 10.17305/bjbms.2018.3544 }}</ref>

===Asymptomatic bacteriuria===
Those who have bacteria in the urine but no symptoms should not generally be treated with antibiotics.<ref name="Ariathianto">{{cite journal | vauthors = Ariathianto Y | title = Asymptomatic bacteriuria - prevalence in the elderly population | journal = Australian Family Physician | volume = 40 | issue = 10 | pages = 805–809 | date = October 2011 | pmid = 22003486 }}</ref> This includes those who are old, those with spinal cord injuries, and those who have urinary catheters.<ref name="Colgan">{{cite journal | vauthors = Colgan R, Nicolle LE, McGlone A, Hooton TM | title = Asymptomatic bacteriuria in adults | journal = American Family Physician | volume = 74 | issue = 6 | pages = 985–990 | date = September 2006 | pmid = 17002033 }}</ref><ref name="AGSfive">{{Citation |author1=American Geriatrics Society |title=Five Things Physicians and Patients Should Question |url=http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |work=Choosing Wisely: an initiative of the ABIM Foundation |archive-url=https://web.archive.org/web/20130901100140/http://www.choosingwisely.org/doctor-patient-lists/american-geriatrics-society/ |publisher=American Geriatrics Society |access-date=1 August 2013 |archive-date=1 September 2013 |author1-link=American Geriatrics Society |url-status=live}}</ref> Pregnancy is an exception and it is recommended that women take seven{{nbsp}}days of antibiotics.<ref>{{cite journal | vauthors = Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A | title = Duration of treatment for asymptomatic bacteriuria during pregnancy | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 11 | pages = CD000491 | date = November 2015 | pmid = 26560337 | pmc = 7043273 | doi = 10.1002/14651858.CD000491.pub3 }}</ref><ref name="Guinto-2010">{{cite journal | vauthors = Guinto VT, De Guia B, Festin MR, Dowswell T | title = Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy | journal = The Cochrane Database of Systematic Reviews | issue = 9 | pages = CD007855 | date = September 2010 | pmid = 20824868 | pmc = 4033758 | doi = 10.1002/14651858.CD007855.pub2 }}</ref> If not treated it causes up to 30% of mothers to develop [[pyelonephritis]] and increases risk of [[low birth weight]] and [[preterm birth]].<ref name=":0" /> Some also support treatment of those with [[diabetes mellitus]]<ref>{{cite journal | vauthors = Julka S | title = Genitourinary infection in diabetes | journal = Indian Journal of Endocrinology and Metabolism | volume = 17 | issue = Suppl 1 | pages = S83–S87 | date = October 2013 | pmid = 24251228 | pmc = 3830375 | doi = 10.4103/2230-8210.119512 | doi-access = free }}</ref> and treatment before urinary tract procedures which will likely cause bleeding.<ref name="AGSfive" />

=== Pregnant women ===
Urinary tract infections, even asymptomatic presence of bacteria in the urine, are more concerning in pregnancy due to the increased risk of kidney infections.<ref name="NA2011" /> During pregnancy, high [[progesterone]] levels elevate the risk of decreased muscle tone of the ureters and bladder, which leads to a greater likelihood of reflux, where urine flows back up the ureters and towards the kidneys.<ref name="NA2011" /> While pregnant women do not have an increased risk of asymptomatic bacteriuria, if bacteriuria is present they do have a 25–40% risk of a kidney infection.<ref name="NA2011" /> Thus if urine testing shows signs of an infection—even in the absence of symptoms—treatment is recommended.<ref name=":0" /><ref name="Guinto-2010" /> [[Cephalexin]] or nitrofurantoin are typically used because they are generally considered safe in pregnancy.<ref name="Guinto-2010" /> A kidney infection during pregnancy may result in [[preterm birth]] or [[pre-eclampsia]] (a state of [[hypertension|high blood pressure]] and kidney dysfunction during pregnancy that can lead to [[seizure]]s).<ref name="NA2011" /> Some women have UTIs that keep coming back in pregnancy.<ref name="pmid26221993">{{cite journal |vauthors=Schneeberger C, Geerlings SE, Middleton P, Crowther CA |date=July 2015 |title=Interventions for preventing recurrent urinary tract infection during pregnancy |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=7 |pages=CD009279 |doi=10.1002/14651858.CD009279.pub3 |pmc=6457953 |pmid=26221993}}</ref> There is insufficient research on how to best treat these recurrent infections.<ref name="pmid26221993" />

===Pyelonephritis===
[[Pyelonephritis]] is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or [[Intravenous therapy|intravenous]] antibiotics.<ref name=Pylo2011/> Seven days of the oral fluoroquinolone [[ciprofloxacin]] is typically used in areas where the resistance rate is less than 10%.<!-- <ref name=Pylo2011/> --> If the local antibiotic resistance rates are greater than 10%, a dose of intravenous [[ceftriaxone]] is often prescribed.<ref name=Pylo2011/> Trimethoprim/sulfamethoxazole or amoxicillin/clavulanate orally for 14 days is another reasonable option.<ref>{{cite book |title=The Sanford Guide to Antimicrobial Therapy 2011 (Guide to Antimicrobial Therapy (Sanford)) |publisher=Antimicrobial Therapy |year=2011 |pages=[https://archive.org/details/sanfordguidetoan00davi_0/page/30 30] |isbn=978-1-930808-65-2 |url=https://archive.org/details/sanfordguidetoan00davi_0/page/30 }}</ref> In those who exhibit more severe symptoms, admission to a hospital for ongoing antibiotics may be needed.<ref name=Pylo2011/> Complications such as ureteral obstruction from a [[Kidney stone disease|kidney stone]] may be considered if symptoms do not improve following two or three days of treatment.<ref name=EM2011/><ref name=Pylo2011/>