Urinary tract infection
Infection of any part of the urinary tract. Uncomplicated cystitis is treated with nitrofurantoin or fosfomycin. Complicated UTI and pyelonephritis may need fluoroquinolones or other broad-spectrum antibiotics.
ICD-10 N39.03 drugs
Also known as: UTI, Cystitis, Pyelonephritis
Drugs used for this condition
- ALevofloxacinSecond line · Third-generation fluoroquinoloneSecond-line for acute pyelonephritis per EAU 2024 and IDSA 2010. Dose 500–750 mg once daily for 5–7 days. Not used in uncomplicated cystitis in non-pregnant women – first-line is fosfomycin or nitrofurantoin (EMA 2019 restriction).
- BTrimethoprimSecond line · Antibacterial, dihydrofolate reductase inhibitorTrimethoprim is used for uncomplicated urinary tract infection in adults when fosfomycin or nitrofurantoin are unsuitable. SEIMC restricts empirical use because of growing E. coli resistance in Spain (above 25% in most regions). Long-term use requires potassium and creatinine monitoring.
- CCranberry (Vaccinium macrocarpon)Add-on therapy · Herbal preparation for recurrent urinary tract infection prevention. In EU – traditional herbal medicinal product (EMA HMPC). AEMPS does not register as medicine; sold as supplementCranberry is one of the few herbal preparations with relatively convincing evidence in recurrent urinary tract infection (UTI) prevention in women. Cochrane 2023 (Williams) updated systematic review of 50 RCTs in 9000 participants: cranberry products (standardised to 36 mg PAC × 1–2 times daily) reduced recurrent UTI frequency in women by 30% (NNT 8–13). EMA HMPC 2017 recognises cranberry as a traditional herbal medicinal product for recurrent UTI prevention. EAU 2024 and AUA/CUA/SUFU 2022 list continuous or post-coital antibiotic prophylaxis (nitrofurantoin 50–100 mg, co-trimoxazole, fosfomycin) first-line for recurrent uncomplicated UTI in women; cranberry is additional option for patient preference and long-term antibiotic intolerance. For established UTI cranberry is ineffective.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit