There's a new treatment for urinary tract infections. What should you know?

[3 min read]

In this article: 

  • The antibiotic, pivmecillinam, has been used in Europe for decades as the primary treatment for patients with uncomplictated urinary tract infections (UTIs). 
  • It's the first new treatment for UTIs approved in the United States in 20 years. 
  • A Swedish expert shares information about UTIs, their treatment and how his newly approved drug can help physicians and patients. 

In late April, the U.S. Food and Drug Administration (FDA) approved the sale of an antibiotic for the treatment of urinary tract infections (UTI); it was the first time in more than 20 years that the FDA approved a new treatment for UTIs, which are becomingly increasingly unresponsive to existing treatments. The antibiotic, pivmecillinam, has been used in Europe for over four decades as the primary treatment for women with uncomplicated UTIs, or infections that have not traveled outside the bladder to the kidneys. 

We spoke with Birte Wolff, M.D., a urogynecologist with Swedish Women’s Wellness, to learn more about UTIs and the importance of this new treatment

What is a UTI? 

They are usually a bacterial overgrowth in the bladder causing bladder symptoms such as pain with urination or urgency of urination

What are common causes? 

The most common bacteria-causing UTI is E.coli, but many others can occur such as Enterococci, Klebsiella and Proteus. But not every E.coli is a bad guy; there are good E.colis and sometimes they are even implanted intentionally to improve the gut microbiome. In the case of E.Coli more important than the name of the bacteria — which is determined by their visible appearance — is their genetic makeup which determines how they behave and whether they are sensitive to certain antibiotics. The bad guy is the one that causes UTI symptoms.  

How are they commonly treated? 

In cases of significant symptoms, we typically recommend antibiotics.

This new drug is recommended for uncomplicated UTI’s. What does that mean? 

We separate UTIs into complicated versus uncomplicated because sometimes UTIs can spread to the kidneys and cause severe illness. Symptoms that suggest possible spread include fevers, upper back pain on the side near the kidney. This is called costovertebral angle (CVA) tenderness which is very different from typical back pain. 

 In addition, certain patients are more sensitive and require faster and enhanced treatment, such as pregnant patients or those with a history of renal transplant. If someone does not have these symptoms of these unique groups, the new antibiotic can be considered. 

Who commonly suffers from UTIs? 

It is pretty common for women to have one or two UTIs in a year, especially in woman who are sexually active or who are postmenopausal.  When UTIs occur in men or there are recurrent infections in women, we begin to wonder about investigation as to underlying causes for the infections such as renal stones or tumors. 

Are they dangerous? Can they affect fertility? 

UTIs are not usually dangerous and can actually be left to run its natural course. The immune system can overcome UTI’s, but it can take some time. Some sensitive groups such as patients with refluxing ureters or other unique groups such as pregnant woman require treatment early because they are indeed at risk for the dangerous spread to the kidneys. 

I am not aware that we have any convincing evidence about UTIs affecting the ability to get pregnant, so I do not think so. However once pregnant it is important to be careful as there are risks associated with pregnancy. 

What are your thoughts about this new drug for patients? What should they know? 

I think it is great that we have another choice because sometimes bacteria get smart (become resistant) and we run out of options for treatment. I think the future of UTI treatment lies in the exciting vaccine developments, and preventative measures that support our healthy microbiome which can protect us from UTI. 

Learn more and find a physician or advanced care pratitioner (ACP)

If you need a gynecologist, women's health specialist or primary care doctor, Swedish is here for you. Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you. 

Information for patients and visitors 

Additional resources

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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.

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About the Author

Whether you are seeking gynecological advice, need help navigating your way through the menopause stage of life or researching a recent breast cancer diagnosis, the Swedish Women's Health Team is committed to helping women find the information they need to live happy and healthy lives.

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