The Right Antibiotic Treatment
Sometimes it’s simply necessary.
I am endlessly grateful that this medication saves so many lives, and that’s precisely why I’m cautious about premature or excessively frequent use. You might agree with me and prefer to try managing without antibiotics initially. But let me tell you: Sometimes you simply can’t win the battle without them.
In cases of a complicated UTI (e.g. in children, men, pregnant women, catheter users, those with diabetes mellitus, immunosuppression, functional or anatomical urinary tract disorders, or kidney problems), as well as in cases of an uncomplicated UTI that shows no improvement after 5 days of self-treatment, a doctor’s consultation and often antibiotic therapy are necessary.
If herbal medicines (phytopharmaceuticals) are no longer effective in an uncomplicated case, antibiotics taken over three days will take up the fight against the pathogens.
A follow-up examination, such as a urine culture, is not necessary if the symptoms of the UTI disappear after treatment. However, if symptoms persist after completing the 3-day treatment, it could mean that either the diagnosis was incorrect, or the antibiotic was ineffective against a resistant strain. If symptoms persist, a urine culture with sensitivity testing (antibiogram) should be performed 6 to 7 days after starting treatment. This will identify the pathogens and their sensitivity to various antibiotics.
For recurrent cystitis: In over 90% of cases, recurrent infections are actually new infections. The bowel and vaginal flora serve as the reservoir for these pathogens. New infections occur after more than 14 days and are treated again with short-term antibiotic therapy. A change of medication is not necessary, as the same pathogen with an unchanged resistance profile is usually present.
Antibiotics are also used for the prophylactic treatment of frequently recurring cystitis (either continuously, at a low dose, or post-coitally).
- Post-coital single-dose prevention: In women with frequent recurrent cystitis associated with sex, a single dose of antibiotics can be taken after each instance of sexual intercourse.
- Long-term prevention: For women with frequent recurring UTIs (at least 2 per half-year or at least 3 per year), who have not responded to behavioural changes and non-antibiotic preventive measures and who are suffering significantly, a continuous low-dose antibiotic prophylaxis over three to six months may be used.
Success comes with consistency: The best strategy is to avoid getting a UTI in the first place. I know it sounds tedious and sometimes it is, but the discipline in prevention and maintenance really pays off. You’re on the best path to a UTI-free life!
Don’t throw in the towel immediately: All of the tips I’ve mentioned for the acute phase can help your (uncomplicated) cystitis heal without antibiotics. Don’t give up on day 1! Remember: I am the living proof that there is hope beyond antibiotics!
Which Antibiotic?
When choosing an antibiotic, various criteria must be considered: For example, the pathogen spectrum and antibiotic sensitivity or regional resistance situation, or an existing pregnancy.
Unfortunately, more and more bacterial strains are becoming resistant to this life-saving medication. Premature and frequent use of antibiotics are reasons for this. To ensure that we can successfully treat bacterial infections in the future, antibiotics should be used more selectively.
The guideline of the German Society for General Medicine on urinary tract infections makes the following recommendations for uncomplicated UTIs: :
- First-line antibiotics: Fosfomycin Trometamol (e.g. Monuril®), Nitrofurantoin (e.g. Uro-Tablinen®, Furadantin®, Nifurantin®), Nitroxoline, Pivmecillinam (Selexid®, Pivmelam®), Trimethoprim (e.g. Infectotrimet®) with resistance rates below 20%. All are well-tolerated, with minimal impact on the body's bacterial flora.
- Second-line antibiotics: Cefpodoxime Proxetil, Ciprofloxacin (e.g. Ciprobay®), Cotrimoxazole (e.g. Cotrim®, Kepinol®, Eusaprim®), Levofloxacin (e.g. Tavanic®), Norfloxacin (e.g. Barazan®), Ofloxacin.
- Not recommended: Cephalosporins and Cefixime (e.g. Infectocef®, Suprax®, Cefastad®, Cefaclor®) are broad-spectrum antibiotics that also affect the physiological vaginal and intestinal flora (in this case, probiotics are indispensable as a supplement and follow-up care).
- Often ineffective: Amoxicillin (e.g. Amoxibeta®, Amoxypen®, Azillin®) is often ineffective due to pathogen resistance.
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Reserve antibiotics - Fluoroquinolones: Norfloxacin, Ciprofloxacin, or Levofloxacin are effective but are referred to as reserve antibiotics in the guideline and should not be prescribed routinely.
The European Medicines Agency warns of potential severe and persistent, possibly irreversible side effects that could impair quality of life. For this reason, its use is restricted: NOT for uncomplicated cystitis, NOT for recurrent lower urinary tract infections (exception: other antibiotics commonly recommended for these infections are considered unsuitable). - Reserve antibiotic Fosfomycin: As a single-dose therapy (e.g. Monuril®), it is effective and well-tolerated but should also not be prescribed routinely, as it is needed as a reserve antibiotic for life-threatening staphylococcal infections.
- Antibiotics for long-term prophylaxis (3-12 months daily or post-coital): Nitrofurantoin, Fosfomycin, Trimethoprim (with resistance rates below 20%)
The Right Supportive Therapy and Aftercare
Break free from the vicious circle of antibiotics versus immune system: Antibiotics weaken the gut and thereby your immune system. A weakened gut or vaginal flora, in turn, promotes bladder infections. Severe bladder infections require antibiotics – and so the nasty cycle begins again.
Here are my very personal tips on this:
- Gut and vaginal flora: Antibiotics can be quite destructive to your microbiome in the gut and vagina, as well as to your urobiome in the bladder. You can actively counteract this with the intake of lactobacilli. Oral probiotic products and/or vaginal capsules ensure that the "good" bacteria are replenished during or immediately after the antibiotic treatment.
- Antibiogram: Very often, the doctor gets it right on the first try, and you receive the appropriate antibiotic for treating your cystitis. However, if the infection recurs, I strongly advise you to ask your doctor for a urine culture with resistance testing (antibiogram). This is the only way to precisely determine which pathogens are colonizing your bladder and which antibiotics they are sensitive to. Here you can view an example of a bacteriological report of a urine culture.
- Gardnerella Vaginalis: It might be the pathogen causing your recurrent UTI. It can also reside in your vagina completely asymptomatically, causing no typical symptoms. Your gynaecologist can clearly identify these culprits through microscopy of a smear (or they may be detected in a bacterial culture ) and initiate appropriate treatment (usually with antibiotics).
- Alternative Supportive Therapy: Taking an antibiotic doesn’t mean you have to abandon all other tips. You can continue to follow all natural remedies, e.g. phytotherapeutics. Just be careful not to overdo it with daily fluid intake, as otherwise, the concentration of antibiotic substances in the bladder might be too low to be effective. While taking antibiotics, tend to drink slightly less rather than too much water.
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SOS Antibiotic: I always keep an antibiotic for short-term therapy at home. I can take it on my own responsibility.
Even though it has only been necessary once in practice (on a business trip abroad), it has taken a lot of pressure off me in everyday life.
With an emergency antibiotic, I no longer had to worry on weekends, during holidays, or on vacation (because, in fact, it was often these worries that magically attracted the bladder infection).
"Very important: Never take antibiotics without probiotics! Broad-spectrum antibiotics, in particular, don't just kill the bad bacteria, they also eliminate the good ones. But you definitely need them in the fight against your bladder infections.
Caution during pregnancy: Not every antibiotic is safe to take during pregnancy. My GP gave me Selexid® (active ingredient Pivmecillinam) as an emergency antibiotic to keep at home."
