Urinary & pelvic health
About testing and urgent treatment for UTI’s
by Marcy Holmes, Women’s Health Nurse Practitioner
At Women to Women, we always encourage women to learn as much as they can about their bodies and their health options. As common as urinary tract infections are, many women are tested and treated without understanding the logic behind their doctors’ methods.
If you think you may have a urinary tract infection, this overview on testing and treatment may be helpful, and learning how to prevent side effects from antibiotic use will certainly benefit you. The more you know about UTI’s, the more you can protect yourself against them, and prevent yourself from developing allergies, sensitivities, and resistance to antibiotics. (See our full article for a more detailed look at UTI’s and how you can prevent them.)
Testing for UTI’s
The primary purpose of testing for urinary tract infections is twofold: to identify the organism at fault for your symptoms and to determine how advanced the infection may have become.
Testing requires a clean-catch (midstream) urine sample, free of contaminants from outside the urinary tract. The clean-catch procedure requires a woman to wipe her vulva and urethral opening with three separate cleansing wipes. After urinating a small amount into the toilet, she uses a sterile cup to catch a midstream urine sample. Care should be taken to apply the cup’s lid without touching the inside of the cup.
Most doctors’ offices have clear instructions on how to collect a clean urine specimen, but sometimes women, especially those with any type of dexterity limitations, may have a bit of difficulty. Occasionally a provider may need to use a urinary catheter to obtain a truly “clean” sample that is uncontaminated by the external region, and a catheterization may also be required to measure the amount of residual urine that is retained in the bladder after voiding (known as post-void residual).
UTI’s are frequently caused by the bacteria known as E. coli or Staphylococcus, but a clean-catch sample is required for the laboratory to culture out and identify which specific species and strain may be involved. For Chlamydia testing, however, the clean-catch sample is not needed, nor is it desired, so a woman has to obtain a separate sample for this test prior to using the wipes for a clean-catch specimen.
Healthcare practitioners can quickly “dip” the urine sample in the office, principally to screen for white blood cells, red blood cells, and nitrites (a by-product of some bacteria). Any of the above can signal infection. The sample is then sent to the lab to be re-dipped and cultured to identify the infectious organism and confirm the choice of antibiotic.
Urgent treatment — antibiotics for UTI’s
Each antibiotic drug works a little differently to remove disease organisms, so it’s important to keep in mind that they all have very specific indications and limitations for their usage, as well as the risk of unwanted side effects. Clearly, appropriate antibiotic choice can truly alleviate unnecessary suffering, but remember that there is always a trade-off. In some geographic regions, strains of antibiotic-resistant organisms have developed due to antibiotic overuse and misuse. If these strains have become common in your area, your healthcare provider’s choices also become more limited when it comes to treating you.
Nitrofurantoin
In general terms, nitrofurantoin is one of the most commonly prescribed antibiotics for UTI’s, especially when caught early enough in the infectious process. Sold under the brand names Furadantin, Macrodantin and Macrobid, nitrofurantoin is often selected when there is a relatively mild infection present, no red blood cells in the urine, or less concern for resistance or deep tissue invasion.
The brand name Macrobid works as a sustained-release (long-acting) antibiotic, so it is sometimes used as long-term therapy for women with uncomplicated recurrent urinary tract infections. In some cases it is offered to women who have UTI’s associated with sexual intercourse to be used prophylactically after sex.
One benefit of nitrofurantoin is that for some women it’s less likely to disrupt the intestinal flora or cause a yeast infection — common side effects of antibiotic treatment.
Stronger choices
One drawback to nitrofurantoin-based antibiotics such as Macrobid and Macrodantin is that they do not reach a sufficiently high concentration in the bloodstream, and therefore do not penetrate to protect the deeper urinary tract tissues or kidneys. For this reason, they are not the first choice when numerous red blood cells are present in the urine sample. Instead, a range of other drugs is considered for more serious urinary tract infections. These include the co-trimoxazole drugs, which are antibiotics combining trimethoprim and sulfamethoxazole, sold under the brand names Bactrim and Septra.
In some cases the trimethoprim component, which contains no sulfur, has been found to be equally effective when used on its own. Using trimethoprim alone has possible advantages not only because large numbers of people are allergic to antibiotics containing sulfur, but also because studies suggest adverse side effects, such as GI disturbance and skin rashes, are less common with trimethoprim alone.
Other choices include ciprofloxacin (Cipro) or the newer-generation antibiotic levofloxacin (Levaquin). These are known as fluoroquinolones, a group of antibiotics that are referred to as “broad-spectrum,” meaning they have the ability to wipe out a range of different types of bacteria in the body.
These antibiotics are considered somewhat “stronger” than nitrofurantoin, in that they do penetrate tissues for more aggressive treatment and are a probably a wiser choice when marked red blood cells are present. They may also be selected if a woman is suffering from recurrent infections. That said, I have concerns about the practice of prescribing strong broader-spectrum antibiotics right away when a woman presents with a UTI. Not only are side effects significant, but this practice is resulting in the unnecessary breeding for resistant organisms worldwide. If the patient is not allergic to sulfa drugs, I tend to start with nitrofurantoin or trimethoprim first, even if a small number of red blood cells are present.
The number of days of treatment is based on severity of symptoms and other features shown in the urinalysis. Obviously, the more advanced the infection, the longer the course of treatment you will need. Mild infections caught early can often be treated in just three days, whereas others need five to seven days. If I have concern for a deeper infection, a one- to two-week course of antibiotics may be needed. For the best outcome with any UTI, the practitioner must treat the patient as an individual, looking at all the variables and choosing the treatment course with care.
For the pain and urgency associated with urinary tract infections, a short course of the analgesic drug phenazopyridine (brand names Pyridium, Urogesic, Urostat) is often given to be used for one to two days in adjunct to antibiotics. Keep in mind, this pain reliever can cause the urine to become distinctly rust-colored, but this is a harmless side effect.
It’s always best to know up front which organisms you’re dealing with, and obtaining, dipping and culturing the urine is ideal prior to starting any course of antibiotics or an analgesic such as Pyridium. Likewise, a “test of cure” a couple of weeks after treatment may be warranted in some recurrent cases to ensure the infection has been fully eliminated.
Preventing side effects from antibiotics
Vaginal and intestinal yeast overgrowth is a common side effect when using antibiotics. To help avert this, we encourage all women treated for UTI’s to avoid sugar as best they can and to take a probiotic supplement daily — not just while taking the antibiotics but for at least a month afterwards.
In some cases women with recurrent UTI’s are prescribed continuous daily antibiotic prophylaxis for a period of 6–12 months and sometimes even longer. This can be a necessary all-out rescue measure in certain cases, but we strongly urge caution regarding the prolonged use of antibiotics. Even though a continuous treatment course of antibiotics may reduce your chances of developing a UTI while you are on them, it will not protect you once you stop the antibiotic and will actually expose you to an increased risk for adverse events.
Plenty of water and fiber in the diet is wise as well, but there’s no need to over-flood your system with water when on antibiotics because excess fluids can possibly dilute their impact on the urinary tract. Just be sure to drink a normal amount, about 8–10 glasses per day.
Preventing antibiotic resistance
If you do have to take an antibiotic to rid yourself of a UTI, remember how important it is to use the antibiotic responsibly. Your practitioner must take care to select and prescribe the correct dosage of the most suitable antibiotic for an appropriate time period, and your responsibility is to follow the prescribing direction to the letter. Always take the full course, don’t share or borrow prescriptions, and please don’t flush unused antibiotics down the drain! These simple guidelines will help you successfully and quickly eliminate the organism that is causing the infection, lower your risk of recurrent UTI’s, and minimize the chances of resistant strains gaining a toehold in your community.
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Related to this article:
References & further reading on UTI testing and treatment
Original Publication Date: 08/23/2007
Last Modified: 03/27/2008
Principal Author: Marcy Holmes, NP