Why not every bladder infection needs an antibiotic
According to the recommendation from smarter medicine / Choosing Wisely, antibiotics should not be routinely taken for an uncomplicated bladder infection (when no complications or risk factors for complications are present) or when bacteria are incidentally found in the urine. This applies regardless of age. Find out what this means for you.
Risk groups and
those commonly affected
Bladder infections are common and most often occur in young females. However, they can occur in older persons and males as well. In individuals without risk factors for complications, we refer to it as an uncomplicated bladder infection.
Typical
complaints
A bladder infection always presents with symptoms. The most common ones are painful and frequent urination and blood in the urine. A urine dipstick can confirm the diagnosis. Fever and flank pain can indicate complications. Treatment is dependent on the type of infection and the patient.
Risk factors and complications
Risk factors for complications:
pregnancy, anomalies of the urinary tract system (e.g., bladder prolapse, malformations), impaired kidney function, diseases that can promote a bladder infection (e.g., diabetes), more than 2 bladder infections yearly, hospitalization within the past 3 months, upcoming urological / gynacological procedure, indwelling urinary catheter, male sex
Possible complications of a bladder infection:
spread of the infection to the renal pelvis, spread of the infection into the bloodstream
What are antibiotics
effective against?
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All types of infections
Bacterial infections
Antibiotics are medications that target bacteria. They are not effective against fungal or viral infections.
Viral infections
Fungal infections
A bladder infection usually requires an antibiotic only when the risk for complications is increased. Without risk factors for complications, a bladder infection resolves spontaneously in 50-70% of cases. Complications occur only in 1-3% of cases and must then be treated with antibiotics.
Benefits and risks
… of not taking antibiotics
for a bladder infection
Reducing the overall use of antibiotics
Reducing the development of bacteria resistance to antibiotics
Avoiding potential side effects caused by antibiotics (abdominal pain, diarrhea, colitis, vaginal yeast infection)
Avoiding drug interactions
Symptoms last about 2 days longer (about 4 instead of 2 days)
1-3% risk for complications
Preventing
bladder infections
Sufficient fluid intake
The optimal amount of fluid intake is individual. Generally, one should drink enough water (about 1.5-2 liters per day) to produce clear urine.
Appropriate contraceptive methods
Avoid contraceptive methods that increase the risk of bladder infections (e.g., diaphragma, spermicides) and urinate immediately after sexual intercourse.
Don’t hold your urine
The longer you hold your urine, the more likely bacteria can grow and settle. Therefore, when you feel the urge to urinate, you should not wait too long before going to the toilet.
Proper genital hygiene
It is important to preserve the body’s natural protective mechanisms. External cleaning with water is sufficient. Do not use soap or shower gel - at most, use a gentle intimate wash lotion.
Wenn I had had my last bladder infection, my primary care provider and I decided to initially forgo an antibiotic. With anti-inflammatory pain medication (ibuprofen) and adequate fluid intake, my symptoms improved within two days.
FAQ
What are incidentally found bacteria in the urine?
Incidentally found bacteria in the urine are referred to as asymptomatic bacteriuria (meaning bacteria in the urine without any symptoms). Without symptoms, these bacteria are harmless and clinically insignificant. They may have entered the urine sample from the skin or digestive tract due to improper urine collection. Therefore, urine should not be tested for bacteria unless there are symptoms consistent with a bladder infection. Exceptions include pregnancy or an upcoming urological or gynecological procedure.
What are the issues with unnecessary use of antibiotics?
Antibiotic resistance:
When bacteria become resistant to antibiotics, they no longer respond to treatment. This means that in the case of a future bacterial infection (regardless of its location), commonly used antibiotics may no longer be effective. The more antibiotics are used, the higher the risk of developing resistance.
Side effects:
Antibiotics destroy the body’s natural bacterial flora. This microbiome consists of ten times more bacteria (1014 = 100 trillion) than the number of human body cells (1013 = 10 trillion). Disrupting this balance can lead to symptoms such as diarrhea or severe intestinal infections.
Drug interactions:
Antibiotics can influence the (side) effects of other medications you are taking (incl. the birth control pill). Their effectiveness may be reduced or increased, potentially leading to complications.
Summary
Without risk factors or signs of complications, antibiotics are likely not required. You can observe the progression of your symptoms for 2 days. Make sure to drink plenty of fluids. Anti-inflammatory painkillers can alleviate your discomfort. However, you should consult your primary care provider in case of fever (at least 38.3°C) or flank pain, if your condition deteriorates or if there is no improvement of your symptoms within 48 hours.
If you have risk factors for complications, you should consult your primary care provider. You can discuss the best management option and whether an antibiotic treatment would be necessary.
Downloads & further information
Discussion with your
primary care provider
Always discuss your thoughts, questions or uncertainties with your primary care provider. If possible, try to go to the appointment well-informed and prepared.