Urinary Tract Infection Medication: What Are the Best Antibiotics for a UTI?

A urinary tract infection (UTI) causes several uncomfortable symptoms that require fast relief. While several antibiotics can cure a UTI, you’ll need a prescription from a healthcare professional. If you’re wondering about your options, here’s what you need to know about antibiotics for treating UTIs.

1. Trimethoprim / sulfamethoxazole (Bactrim, Septra)

Trimethoprim / sulfamethoxazole (Bactrim) is a combination medication that contains two antibiotics: trimethoprim and sulfamethoxazole. It also goes by TMP / SMX. Together, this powerful combination prevents bacteria from making the proteins they need to survive.

TMP / SMX generally works well for treating UTIs. But, in some places, Bactrim has become less effective due to antibiotic resistance. 

2. Nitrofurantoin (Macrobid, Macrodantin)

Nitrofurantoin is an antibiotic that specifically treats UTI in the bladder (cystitis). Nitrofurantoin works by building up in the bladder and keeping bacteria from making the DNA and proteins they need to survive. 

3. Fosfomycin (Monurol)

Fosfomycin can treat UTIs caused by bacteria that are resistant to common antibiotics. It works by killing UTI-causing bacteria and preventing them from sticking to the urinary tract lining.

4. Pivmecillinam

Pivmecillinam (Pivya) and amoxicillin / potassium clavulanate (Augmentin) belong to the penicillin class of antibiotics. 

Amoxicillin / potassium clavulanate isn’t always a first-choice option due to antibiotic resistance. But it can work for some people, including children.

Pivmecillinam is an antibiotic used to treat UTIs in adults. It’s typically reserved for people who can’t take first-choice antibiotics or who have infections caused by bacteria that are resistant to more commonly used antibiotics.

5. Cephalosporins

Cephalosporins are a class of antibiotics that are related to penicillins. These antibiotics kill bacteria by destroying one of its most important components: the cell wall. Cephalosporins are often used to treat UTIs in children. Cephalosporins that can treat UTIs include:

• Cephalexin (Keflex)

• Cefdinir (Omnicef) 

• Cefixime (Suprax)

• Cefuroxime (Ceftin)

6. Ciprofloxacin (Cipro) or levofloxacin (Levaquin)

Ciprofloxacin (Cipro) and levofloxacin (Levaquin) are antibiotics that keep bacteria from copying their DNA and multiplying. These antibiotics work slightly better than amoxicillin / potassium clavulanate, cefdinir, and cephalexin. But the risk of serious side effects is slightly higher. These antibiotics are used to treat complicated or severe types of UTIs.

How do antibiotics treat a UTI?

Bacteria are the most common cause of UTIs. Antibiotics treat a UTI by eliminating bacteria that cause the infection. Antibiotics for UTIs either kill the bacteria or stop it from growing. Not all antibiotics can eliminate UTI-causing bacteria, even if they can eliminate other types of bacteria.

What are potential side effects of antibiotics for UTIs?

Most antibiotics can cause some degree of stomach upset like nausea, vomiting, and diarrhea. If you have severe diarrhea or diarrhea that lasts more than 2 days, let your healthcare team know. Diarrhea is a common antibiotic side effect. In some cases, though, it may be a sign of a more serious C. diff infection. 

Some people are also sensitive to antibiotics. This could result in a minor reaction like hives or a more serious reaction like anaphylaxis. Some people can also develop severe cutaneous adverse reactions (which primarily affect the skin). This includes conditions like DRESS or SJS. If you have difficulty breathing or notice major skin changes after taking an antibiotic, get medical help right away.

How long do you need to take antibiotics to treat a UTI?

Most UTIs require 3 to 7 days of treatment. But how long you take antibiotics for a UTI depends on how severe your UTI is and which antibiotic you’re prescribed. Some medications, like fosfomycin, require only 1 dose. But a more severe UTI might need treatment for 14 days or more. 

You should start feeling better within 1 to 2 days of starting antibiotics. But if you have a severe UTI or you’ve had symptoms for a while before starting antibiotics, it may take a few more days to notice improvement.

It’s important to take all the antibiotics you’re prescribed, even if you start feeling better before finishing them. Stopping antibiotics early can lead to antibiotic resistance. This means the medication might not work as well in the future. It can also cause your UTI to return if the infection isn’t fully treated.

Do you really need to take antibiotics for a UTI?

Most people need to take antibiotics for their UTI to go away. While a UTI may sometimes go away on its own, this doesn’t usually happen. Plus, an untreated UTI can turn into a more serious infection, like pyelonephritis (a kidney infection) or even a blood infection that can cause life-threatening sepsis.

A few things put you at higher risk for developing a serious infection, including pregnancy, underlying health conditions, and being age 65 and older. So, it’s best not to wait to see if your symptoms improve. Seek medical care right away.

Can UTI symptoms linger after you take antibiotics?

UTI symptoms usually start improving within 1 to 3 days of starting antibiotics. If your symptoms aren’t getting better within this time frame, or if they continue after finishing your antibiotics, talk with your healthcare team.

They’ll want to make sure the antibiotics actually worked against your UTI. To do this, they may take another sample of your urine to see if there’s still bacteria. If the infection is cured, you’ll want to be sure there isn’t a different issue that’s causing similar symptoms.

Are there over-the-counter antibiotics for UTI treatment?

UTI symptoms can be uncomfortable. And, since all antibiotics require a prescription, you may wonder if an over-the-counter (OTC) treatment from your local pharmacy is worth considering. 

There are OTC medications that can help ease UTI symptoms while you wait for antibiotics to kick in. Products like AZO and Uristat can help relieve burning and pain. But they aren’t antibiotics, meaning they won’t treat your UTI. That’s why it’s important to take them along with prescribed antibiotics.

When should you seek care for a UTI?

You should seek medical care as soon as you notice UTI symptoms, such as:

• Pain or burning with urination

• Blood in your urine

• Feeling like you have to go to the bathroom more often

• Feeling like you can’t completely empty your bladder

The sooner you get diagnosed, the sooner you can start treatment. Starting treatment early reduces your risk of developing problems like kidney infections (pyelonephritis) or serious infections (sepsis). Early treatment also helps you feel better faster. 

If symptoms appear after regular office hours, call your healthcare team’s after-hours helpline. Most people can wait 24 hours to start antibiotic treatment. But people who are pregnant, have kidney conditions, or have weakened immune systems shouldn’t wait. Your healthcare team can help you figure out if you need to be seen at an urgent care center or emergency room (ER). They can also let you know if you can wait for a regular appointment.

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Written by:

Tracy Norfleet, MD, FACP

Dr. Tracy Norfleet is a board-certified Internal Medicine physician, health expert, and physician leader with over 20 years of experience practicing adult medicine. Dual-certified by the American Board of Obesity Medicine and the American Board of Lifestyle Medicine, Dr. Tracy possesses a wealth of knowledge and expertise in both traditional medical practices and innovative lifestyle interventions for chronic disease management and reversal.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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