Should You Take an Antibiotic for a UTI?

Many women wonder if they should not take an antibiotic for a urinary tract infection because of resistant strains of bacteria. Here's what you should know.

Many women struggle with their bladders yet worry about taking antibiotics. 

Symptoms of a UTI

The symptoms of cystitis, also known as bladder infection or urinary tract infection (UTI), are familiar:

• Pain when you pee
• Frequent small pees
• Urgency, feeling that you’ll wet your pants if you don’t reach the toilet immediately
• Needing to pee but nothing coming out
• Fever
• Chills
• Back pain
• Nausea or vomiting

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When the pain is intense and keeping you home by the toilet, you may not be able to work. If you don’t seek treatment and the infection lingers, it could move into your kidneys, which can be dangerous. 

The standard remedy is a one or three-day course of antibiotics. But that can lead to trouble down the line. The bacteria that cause UTIs are developing resistance to common antibiotics. You also don’t want to take antibiotics unnecessarily or too often — or take the wrong one.

Don’t assume you have resistant bacteria in your system just because you have more than one infection within a few months. An estimated 25 percent of women have a second UTI within six months. Women who get UTIs frequently can suffer more than seven in a year. The average number is between two and three. It’s also common for UTIs to come in a cluster, near each other. 

You’re more likely to have an antibiotic-resistant infection if you are older than 60, have a chronic medical problem, or took other antibiotics during the past year for any reason, including UTIs. A trip abroad or hospital stay are also risk factors. Your doctors will look for alternative treatments. 

Risk factors for frequent UTIs include:

• New sexual partners
• Using a diaphragm, cervical cap, or condom, with or without a spermicide
• A tendency towards UTIs in your family
• Wiping back to front instead of front to back

How to diagnosis a UTI

You can buy over-the-counter painkillers designed for cystitis and an over-the-counter “dipstick” test. The test is easy: You pee on it, preferably first thing in the morning, and wait three minutes. The test will give you two readings, one for nitrite and another for leukocyte, or white blood cells.

A negative result or milder symptoms are reasons to drink lots of water and wait a day. Some women think they have an infection even when it has already resolved. Post-menopausal women sometimes experience urgent and frequent peeing without an infection. 

Being positive on both readings is a strong indication that you have an infection. But you may get an ambiguous result. You may also have an infection even if the dipstick isn’t positive on either reading.

Talk to your doctor about your symptoms. Depending on what you report, a doctor may prescribe an antibiotic. Especially if you have a recurrent problem, doctors will ask you to provide a urine sample to have it tested for bacteria.  

You may be tempted to skip the lab test and prefer to take an antibiotic rather than wait for results; the culture will take more than 24 hours. That’s taking a risk. Some women worry that they’re taking a bigger risk of a kidney infection if they wait.

The risk of a serious infection probably isn’t greater if you wait for the results of a culture, and you’re less likely to take an antibiotic and have a recurrence.

You may need to see a urologist to identify other causes. Tests might include:

• A type of x-ray called an intravenous pyelogram, which involves injecting a dye into a vein and taking pictures of your kidney and bladder
• An ultrasound exam, which gives a picture of your kidneys and bladder using sound waves
• A cystoscopic exam, which uses a hollow tube with special lenses to look inside your bladder

What you can do

To prevent future UTIs, you’ll hear advice to:

• Urinate immediately after intercourse
• Take cranberry pills or drink unsweetened juice
• Take probiotic pills
• Take methenamine salts

Although the evidence is not strong for any of those strategies, they may be worth a try.

Post-menopausal women may benefit from estrogen suppositories, which may pose fewer risks than oral hormone replacement. 

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