Long-Term Antibiotics for Chronic UTIs: A Comprehensive Guide
The other day, I spoke with an elderly woman whose doctor had prescribed taking long-term antibiotics for her chronic UTI. She expressed her frustration, saying, “I am eighty years old and I don’t want to be taking these antibiotics, but I am not sure what to do. There are so many other things that I could try, but I don’t know where to start.” We hear this concern often and can provide some guidance based on our extensive research over the past five years and the success stories from women who have recovered from chronic UTIs.
This is the first in a two-part series on available treatments for UTIs: “antibiotics” and “natural alternatives to antibiotics.”
Understanding Antibiotic Treatment for UTIs
When prescribed antibiotics, it is essential to understand what they are and how they work. You have the right to ask your doctor for more information before taking them.
Antibiotics are medications used to fight infections caused by bacteria. They treat infections by killing bacteria or inhibiting their growth. They attack the wall or coating surrounding the bacteria and interfere with bacterial reproduction.
Fact: Antibiotics Are Less Effective for UTIs Today
Typically, doctors prescribe antibiotics for 3-5 days to treat UTIs, assuming they will eradicate all the bacteria in the bladder. However, this is no longer always the case.
Approximately 40% of women treated with antibiotics for a UTI return to the doctor within a month with another infection. This issue is linked to the “antibiotic resistance crisis,” which is well-documented by the CDC. The factors contributing to this crisis include:
- Overprescribing of antibiotics by medical professionals
- Bacterial evolution, allowing bacteria to evade antibiotics by hiding in biofilms and mutating, causing continuous infections
- ESBL enzymes produced by gram-negative bacteria such as E Coli, which are resistant to the most common antibiotics
Fact: The Antibiotics Crisis Is Worsening for UTI Sufferers
In a Kaiser Health News article published in August 2022 contained this warning: “Forget COVID-19, monkeypox and other viruses for the moment and consider another threat troubling infectious disease specialists: common urinary tract infections, or UTIs, that lead to emergency room visits and even hospitalizations because of the failure of oral antibiotics.”
Pharmaceutical companies are not motivated to develop new antibiotics due to insufficient profit potential. Additionally, the few companies that have sought approval for new antibiotics have been turned down by the FDA. Although some senators are advocating for government funding under a new “PASTEUR” program, it will likely take years to see any progress.
Fact: More Analysis Should Be Done Before Prescribing Antibiotics
Antibiotics also don’t work well unless the doctor takes the time to do the right analysis and testing up front to define which medication you should be on before writing a prescription.
A recent NIH article revealed that a significant proportion of antibiotics are prescribed without confirming either the presence of a UTI or the type of UTI.
First, he/she needs to identify whether the UTI is “uncomplicated” or “complicated.” An “uncomplicated UTI”. An “uncomplicated UTI” is the most common and means that the urinary tract is normal. A “complicated UTI” indicates an issue with the urinary tract, such as a blockage from kidney stones or an enlarged prostate (in men).
Second, a urine culture should be conducted to identify the bacteria present and prescribe the most effective medication. Often, only a dipstick test is done to confirm the presence of bacteria, leaving the type of bacteria undiagnosed. While about 75% of all UTIs are caused by E. coli, 25% are due to more difficult-to-treat infections.
Third, the doctor needs to prescribe the most effective antibiotic for the specific type of bacteria. Not all antibiotics are the same when it comes to getting rid of the E Coli bacteria, as shown in the chart below. For example, for the typical uncomplicated UTI, Macrobid (nitrofurantin) is the most effective, followed by Monurol (fosfomycin).
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Fact – Antibiotics May Have Serious Side Effects
The FDA has just issued a warning saying that Cipro, in addition to other antibiotics, should not be prescribed for UTIs unless there are no other options; read more here.
Antibiotics alter the intestinal flora, which can result in an immune misbalance leading to obesity and inflammatory bowel disease.
In addition, the following specific side effects have been reported (about 1 in 10 patients):
- Nausea
- Diarrhea
- Dizziness, lightheadedness
- Headache
- Trouble sleeping
Other severe and less common side effects include:
- New signs of infection (fever)
- Eye pain, vision changes
- Mood changes
- Easy bruising/bleeding
- Ruptured tendons, tendonitis
Fact – Long-Term Antibiotics Should Not be Prescribed – Especially To Seniors
Some doctors prescribe antibiotics to be taken over a period of months to help stave off future UTIs. This was a fairly common practice among seniors living in community settings where UTIs often turned into kidney infections and hospital emergencies.
The CDC now recommends against this, as it caused more harm than good.
A study published by Clinical Infectious Diseases showed that long-term antibiotic treatment (over 30 days) is associated with an increased risk of antibiotic resistance, hospitalization or emergency department visits, bloodstream infection, and sepsis among older adults aged 66 years or older.
If you are taking antibiotics on a long-term basis, you should ask your doctor what other alternatives are available.
Part 2 of this blog discusses Natural Alternatives to Antibiotics. Click here to continue reading.
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