Urinary Tract Infection Treatment: A Complete Guide

When it comes to treating urinary tract infections (UTIs), antibiotics continue to be the No. 1 go-to treatment. Most often, these drugs come in the form of pills that are taken orally, often over a period of several days.

See your doctor if you have symptoms of a UTI, such as needing to urinate more often, pain or burning when you urinate, and cloudy or discolored urine.

They can prescribe different kinds of antibiotics, depending on your individual circumstances, and recommend other treatments to help you feel better and keep UTIs from coming back.

The type of antibiotics you need — and how long you’ll take them — depend on the type of bacteria detected in your urine, your health status, and whether your UTI is uncomplicated or complicated.

If you’re a woman who’s healthy, your urinary tract is anatomically and functionally normal, and you aren’t unusually vulnerable to UTIs, your UTI is considered uncomplicated, or simple.

Most other UTIs are considered complicated. They may include the following:

You have urinary tract abnormalities.
You’re pregnant.
The patient is a child.
You have a condition that increases the risk of infection or treatment resistance, such as poorly controlled diabetes.
You have immune system problems.
You’re a man, although in certain cases, UTIs in men can be considered uncomplicated.
You’re elderly.

With a complicated UTI, you may get antibiotics intravenously (IV) or by injection at the hospital to start, then oral antibiotics to take at home for 10 to 14 days.

Another important consideration is antibiotic resistance, which is when bacteria become resistant to antibiotics, making the treatment no longer effective. In most cases, your doctor will order a urine culture to determine exactly which bacteria is causing your infection, then get the antibiotic that works best against that germ. You may start with a broad-spectrum drug, then switch to something targeted once the results of the culture come back.

Many UTI medications combine an antibiotic with a drug designed to keep the bacteria from developing resistance.

Usually, pain and the frequent urge to urinate subside after a few doses of an antibiotic. Regardless of the medication prescribed or how quickly you feel relief, it’s always important to complete the entire course of antibiotics as directed by your healthcare provider. If UTIs are not fully treated, they can easily return.

If you still have symptoms after you’ve completed your course of antibiotics, you should have another urine culture to make sure you’re taking the most effective drug.

For recurrent urinary tract infections, defined as three or more UTIs within 12 months, or two or more occurrences within six months, your doctor might prescribe antibiotics at the first sign you have another UTI. You should still get a urine culture to make sure what you have isn’t resistant to the drug you’re taking. You might also be given antibiotics to take daily or after sex.

These are the most common types of antibiotics used to treat UTIs.

Nitrofurantoin

This broad-spectrum antibiotic works against most of the bacteria that cause UTIs. Brand names include Macrodantin and Macrobid. Unlike other antibiotics, nitrofurantoin has a low potential for antibiotic resistance and has an 88 to 93 percent cure rate.

Nitrofurantoin is a first-line treatment for uncomplicated UTIs, and is taken for five to seven days. It may also be prescribed for some complicated UTIs, and as a preventive treatment for recurrent UTIs. Because of its potential effects on a fetus, nitrofurantoin is only used during pregnancy under certain circumstances.

It generally doesn’t work well if the kidneys or prostate are involved.

Nitrofurantoin doesn’t usually cause serious side effects, but you may experience nausea, vomiting, or diarrhea.

Trimethoprim-Sulfamethoxazole

This is a combination of two antibiotics called sulfonamides. It's also known as co-trimoxazole or TMP-SMX. Brand names include Bactrim and Septra. While this treatment is 90 to 100 percent effective, resistance to the drug is increasing.

TMP-SMX is another first-line treatment for uncomplicated UTIs, and can be used preventively. It’s also an effective treatment for UTIs in men.

Because of potential effects on a fetus, it’s usually only prescribed in certain cases for pregnant women.

TMP-SMX may cause sun sensitivity. It can also cause a serious skin reaction and make you vulnerable to infection from C. difficile bacteria, which causes severe diarrhea.

Fosfomycin

This one-dose UTI antibiotic treatment has a cure rate between 83 and 91 percent.

Fosfomycin (Monurol) is a first-line treatment for uncomplicated UTIs and is also considered a safe choice during pregnancy.

It has also been linked to increased antibiotic resistance.

Fosfomycin doesn’t usually cause serious side effects, but you may experience nausea or diarrhea.

Penicillins

These antibiotics, in the beta-lactam class, generally aren’t used to treat uncomplicated UTIs because of high rates of drug resistance, but there are exceptions. They may also be used as an IV treatment for complicated UTIs. These drugs have lower clinical and bacterial cure rates than first-line treatments.

Pivmecillinam (Pivya) is approved to treat uncomplicated UTIs caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis bacteria. It’s taken for three to seven days.
Amoxicillin-clavulanate (Augmentin ES) combines a penicillin antibiotic with a drug to prevent resistance. It may be used to treat an uncomplicated UTI if a urine culture shows it’s the most effective drug.
Ampicillin and sulbactam (Unasyn) this combination drug may be given intravenously for a complicated UTI.

Penicillins are usually well-tolerated, although some people can have an allergic reaction and develop a rash.

Cephalosporins

These beta-lactam antibiotics are considered a second-line treatment for uncomplicated UTIs, usually taken for five to seven days. They may also be given by IV or injection to treat complicated UTIs, including severe infections that are resistant to other antibiotics. They include:

cefdinir
cefepime
cefiderocol (Fetroja)
cefpodoxime
ceftazidime-avibactam (Avycaz)
ceftolozane-tazobactam (Zerbaxa)
ceftriaxone
cephalexin

Cephalexin has been shown to be safe for pregnant women and can be used as preventive treatment for recurrent UTIs.

Cephalosporins don’t usually cause serious side effects, although you may experience nausea and vomiting. If you’ve had an allergic reaction to a penicillin or other beta-lactam drug, you should not take them.

Fluoroquinolones

These antibiotics are considered highly effective in the treatment of UTIs. However, they can have serious side effects. For uncomplicated UTIs, experts say fluoroquinolones should only be used in patients who have no other treatment options.

The following are recommended for treating complicated UTIs:

Because of the risk of harm to the fetus, they generally aren’t used during pregnancy.

They aren’t common, but some of the side effects of fluoroquinolones can be serious. They include damage to your tendons, muscles, joints, and nerves. These drugs can cause extremely low blood sugar, which can lead to coma, and mental health side effects like agitation and trouble concentrating.

Carbapenems

Another type of beta-lactam antibiotic, carbapenems are often considered a drug of last resort.

They are used to treat complicated UTIs caused by drug-resistant bacteria, and may be paired with a drug that fights the germ’s resistance mechanisms. These drugs are administered by IV and include:

imipenem or imipenem, cilastatin, and relebactam (Recarbrio)
meropenem or meropenem and vaborbactam (Vabomere)
ertapenem

Common side effects include nausea and vomiting. It’s rare, but these drugs can cause seizures at high doses, especially imipenem.

Sulopenem Etzadroxil and Probenecid

The combination drug (Orlynvah) received FDA approval in 2024 to treat uncomplicated UTIs caused by E. coli, Klebsiella pneumoniae, or Proteus mirabilis in women who can’t take other antibiotics.

It’s a beta-lactam antibiotic that is taken for five days.

Potential side effects include nausea, vomiting, diarrhea, and vaginal yeast infections. It can lead to C. difficile diarrhea, and shouldn’t be used if you have gout or kidney stones.

Aminoglycosides

Antibiotics in this class, particularly gentamicin, may be combined with other drugs in the IV treatment of complicated UTIs.

Another aminoglycoside, plazomicin (Zemdri) is designed to be used against drug-resistant bacteria and is approved for people who have few or no other options.

These drugs can cause hearing loss and kidney damage.

In addition to antibiotics, your doctor may recommend medications to relieve pain associated with UTIs or prevent them from coming back.

Phenazopyridine

Phenazopyridine (Pyridium) numbs the lining of the urinary tract to make urination more comfortable while you wait for antibiotics to work. It’s also available in over-the-counter (OTC) versions at lower strengths.

This medication is meant to be taken for no more than two days. It may also make your urine turn bright orange, which can interfere with your urine test results.

OTC Pain Relievers

Medicines like acetaminophen and ibuprofen may be all you need to control pain. Ask your doctor what they recommend.

Methenamine

Methenamine (Hiprex, Urex) helps to control the growth of bacteria in your urine. It can be prescribed to help prevent recurrent UTIs.

OTC versions with an anti-inflammatory added can relieve pain while you’re getting antibiotic treatment. If you’re pregnant or breastfeeding, consult your healthcare provider before taking this drug.

Vaginal Estrogen

For peri- and post-menopausal women with recurrent UTIs, vaginal estrogen therapy is recommended to reduce the risk of future UTIs. These medications come in either the form of a ring or tablet insert, or creams.

While antibiotics are the standard first-line treatment of UTI, there are some things you can do at home to help relieve symptoms. These include:

Drink plenty of water. Consuming at least six to eight 8-ounce glasses of water daily can help flush away UTI-causing bacteria, setting you up for a quicker recovery. Plus, the more you drink, the more you’ll have to urinate.
Urinate often. Each time you empty your bladder, you’re helping to flush bacteria out of your system.
Try heat. Applying a heating pad to your pubic area for 15 minutes at a time can help soothe the pressure and pain caused by UTI-related inflammation and irritation.
Cut out certain irritants. Caffeine, alcohol, spicy food, raw onions, citrus fruits, carbonated drinks, artificial sweeteners, and nicotine can further irritate your bladder, making it more difficult for your body to heal.

What About Cranberry Juice?

It’s a long-held belief that drinking cranberry juice may help prevent and treat urinary tract infections. While it’s true that cranberries contain an active ingredient (proanthocyanidins, or PACs) that can prevent bacteria from adhering to the urinary tract, there is still no evidence that cranberry products can treat an active UTI.

There’s a bit more weight to the idea that cranberries can help prevent UTIs. One review of 50 studies showed that taking cranberry products, including juice, tablets, and capsules, reduced the number of UTIs among certain groups, including children and women with recurrent UTIs.

But urologists caution that there isn’t a lot of high-quality research on the topic, and no consensus about what concentration of PAC or dosage might be useful.

Many serious complications can result from not treating a UTI, including:

Recurrent UTIs
Premature birth and low birth weight
Kidney damage
Sepsis, a potentially life-threatening immune system reaction

Call your doctor if your symptoms aren’t getting better after two or three days of treatment, or if they get worse. They may need to switch you to a different antibiotic. You should also get help if you develop a fever, chills, back pain, or vomiting.

The Takeaway