Antibiotics

The other day I was talking to a woman who said that her doctor had put her on long-term antibiotics to deal with her chronic UTI.  She said “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 quite often and can provide some guidance, based not only on the ongoing medical research that we’ve done over the past five years, but also based on 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”.

Antibiotic Treatment for UTIs

If you’re taking antibiotics, you should know what they are and how they work. And 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 and/or decreasing the growth of bacteria.  They attack the wall or coating surrounding the bacteria and interfere with bacteria reproduction.

Fact – Antibiotics Are Less Effective For UTI’s Today

If you’re diagnosed with a UTI, most doctors will prescribe antibiotics for 3-5 days, during which time it is assumed that they will kill all the bacteria in your bladder.  This is no longer the case.

Approximately 40% of all women treated with antibiotics for a UTI will be back in the doctor’s office again within a month with another infection. This is due to the “antibiotics resistance crisis” which is well documented by the CDC and is due to several factors:

  • overprescribing of antibiotics by medical professionals;
  • bacterial evolution which has allowed them to evade antibiotics by hiding in slimy sacs called biofilms and mutating there, causing continuous infections; and
  • ESBL enzymes produced by gram-negative bacteria such as E Coli, which are resistant to the most common antibiotics.

Fact – The Antibiotics Crisis Is Only Getting Worse 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.”

The bottom line is that pharmaceutical companies do not see sufficient profit potential in developing new antibiotics, and the few who have tried to get approvals for new medicines have been turned down by the FDA.  A few senators are trying to get government funding under a new “PASTEUR” program, but this is likely to take years.

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.

And yet, a recent NIH article showed that a large proportion of antibiotics are currently being prescribed without confirming either the presence of a UTI or the type of UTI.

First, he/she needs to define whether you have an “uncomplicated UTI” or a “complicated UTI”.  An “uncomplicated UTI” is the most common and means that your urinary tract is normal.  A “complicated UTI” means there is a problem with your urinary tract, such as a blockage from kidney stones or an enlarged prostate (in men).

Second, he/she should do a urine culture to identify which type of bacteria are present and then prescribe the most effective medication for those bacteria. Often, only a dipstick test is done to confirm the presence of bacteria, but the type of bacteria goes undiagnosed.  While it is true that about 75% of all UTIs are caused by E Coli, that leaves a full 25% with a more difficult-to-treat infection.

Third, he/she 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.