UTI Treatment Is in Crisis

The way doctors treat urinary tract infections may be wrong, and antibiotic resistance is growing

Credit: Wladimir Bulgar/Science Photo Library/Getty Images

Urinary tract infections (UTIs) are one of the most common bacterial infections. By some estimates, 50% of all women experience a UTI in their lifetime, and half of those women will get more than one.

The infection is thought to be caused by gut bacteria like E. coli entering the bladder, resulting in feelings of pressure, discomfort, and pain, along with a nearly constant need to pee. If left untreated, the infection can move to the kidneys and, on rare occasions, can even turn deadly. Sex can sometimes contribute to the infection, but it’s not always the cause. Anything that results in bacteria coming into contact with the urethra increases risk.

A single course of antibiotics usually clears things up, but drug-resistant strains of bacteria are on the rise, making recalcitrant infections more common. Standard antibiotic treatments fail in 25% to 35% of people who take them, which worries doctors because antibiotics are the best and often the only way to treat UTIs. Some doctors are concerned that they may one day run out of options.

“Antibiotic resistance — not just [for UTIs] but all kinds of antibiotic resistance — is a huge problem, and no one’s really doing anything about it,” says Bradley Frazee, MD, an emergency medicine physician at Highland Hospital in Oakland, California, who recently published a study about the emergence of a particularly scary strain of drug-resistant UTI. “There’s not enough money in it, and if you talk about oral antibiotics for urinary tract infections, it’s even worse, because that’s [considered to be] kind of a ho-hum problem.”

The dramatic increase in resistant infections — up 8% and 15%, respectively, for two of the most common antibiotics over a 10-year period — has shifted the way Frazee and other doctors approach UTI treatment. When a person first presents with symptoms, the doctor typically prescribes a standard antibiotic while they wait for the urine culture results. But increasingly, doctors are noticing that cultures come back showing signs of bacterial resistance, and so the doctor has to prescribe a different drug.