
One of the most common bacterial infections is urinary tract infections (UTIs). Millions of people experience this infection annually. It arises when bad bacteria, usually Escherichia coli (E. coli), invade the urinary system, including the bladder, kidneys, urethra, and ureters. There can also be accompanying symptoms such as pain or burning while urinating, a frequent urge to urinate, cloudy or foul-smelling urine, and lower abdominal discomfort.
In treating UTIs, the first line of defense is antibiotics. However, there are several types of antibiotics, and not all are the same in treating every case of UTI. Azithromycin is a popular antibiotic that is prescribed for a wide range of bacterial infections, such as respiratory tract infections, skin infections, and some sexually transmitted diseases. Will azithromycin treat urinary tract infections Let’s take a closer look at this.
Understanding Azithromycin: What Is It?
Azithromycin is a macrolide antibiotic that inhibits bacterial protein synthesis. This action stops the bacteria from growing and multiplying, thus helping the body’s immune system to fight off the infection. It is used for the treatment of:
- Respiratory infections: pneumonia, bronchitis, sinusitis
- Skin infections: acne, cellulitis
- Sexually transmitted infections: chlamydia, gonorrhea
- Ear infections: otitis media
Due to the broad-spectrum activity, azithromycin is effective against various pathogens. However, its utility in urinary tract infections has some limitations.
What causes UTIs?
The most common cause of UTIs is bacteria; among them, Escherichia coli (E. coli) constitutes about 80-90% of episodes. Other common bacteria responsible for causing UTIs are Klebsiella, Proteus, Enterococcus, and Staphylococcus, which are generally sensitive to various classes of antibiotics.
Most UTIs include cystitis, which is localized towards the bladder, and/or urethritis, localized at the urethra. However, the infection may ascend into the kidney, pyelonephritis—a more severe form of this disease. For most UTI treatments, in most cases, antibiotics are applied to the infective bacteria:
Is Azithromycin Effective for UTIs?
Azithromycin is not on the first-line treatment of UTI. In the spectrum of activity against antibacterial pathogens that does not preferentially target more urinary pathogens than E. coli, the causes of the pathogens in the large majority. In fact, it was found not so effective with a common set of pathogens to treat UTIs with but appears somewhat related to drugs of classes than;
- Trimethoprim-sulfamethoxazole (Bactrim).
- Nitrofurantoin (Macrobid)
- Fluoroquinolones (Ciprofloxacin, Levofloxacin)
- Cephalosporins (Ceftriaxone, Cephalexin)
These antibiotics best act on E. coli and other common UTI pathogens.
However, in the following circumstances, azithromycin might be given for UTI.
- Non-E. coli pathogens: Extremely rarely, in the most unlikely circumstances, if a bacterium that causes UTI is susceptible to azithromycin, then it might be given—for instance, Chlamydia trachomatis or Mycoplasma genitalium.
- Complicated UTIs: In case the patient has a complicated UTI due to concomitant infection, such as a sexually transmitted disease (such as chlamydia), azithromycin can be used together with other drugs for a holistic approach.
- Drug Resistance: If the bacteria are resistant to the usual prescription of drugs for UTI, then azithromycin could be the alternative prescription, provided the urine culture and sensitivity test return within proper ranges.
Why Isn’t Azithromycin a Go-To Choice for UTIs?
- Target Bacteria: Unlike these above-said facts, azithromycin doesn’t cover E. coli effectively. Since most of the UTIs are caused by E. coli, nitrofurantoin, ciprofloxacin, and trimethoprim-sulfamethoxazole are more effective.
- Urinary penetration: Azithromycin has poor penetration of the urinary tract compared to most antibiotics. It tends to accumulate in tissues, such as lung tissue, skin, and genital organs, thus not being too ideal for use in urinary tract infections.
- Overuse of Azithromycin: Overuse has made people suffer from antibiotic resistance problems, where microbes grow resistant to the drugs used for their destruction. This has been more of an issue with urinary infections in that resistance becomes a limiting factor in treatment.
- Other Effective Alternatives: More specific antibiotics are available that provide more coverage for the common pathogens causing UTIs. This reduces the appeal of using azithromycin in treating UTIs, especially when its broader spectrum also means potential resistance.
When Is Azithromycin Used for UTIs?
Azithromycin may be prescribed in specific conditions where the causative pathogen is suspected to be atypical, such as
- Sexually transmitted infections: For instance, in the case of a complicated UTI accompanied by another co-infection, such as chlamydia or gonorrhea, azithromycin may be added to the treatment regimen.
- Uncommon pathogens: The medication may be prescribed if the UTI is caused by any other E. coli-unrelated pathogens that respond to azithromycin.
These are, however, rare incidences, and azithromycin is not the preferred agent for treating UTIs.
What to Do If You Have a UTI
If you suspect you have a UTI, you should go see a doctor. The healthcare provider would undertake a urine culture and sensitivity test to identify the specific bacteria causing the infection. The doctor will then prescribe the most effective antibiotic based on your specific case. Self-diagnosing and self-medicating with azithromycin is not advisable since it may not target the right bacteria and may contribute to antibiotic resistance.
Role of PGx Testing in Optimizing Azithromycin Treatment of UTI
The pharmacogenomic study will consider the influence of the individual’s genetic makeup on how his or her body would react to a given drug, such as an antibiotic like azithromycin. Pharmacogenomic testing is employed both diagnostically and in the treatment process of UTI. Based on genetic variation causing altered metabolism, PGx testing reports to a provider on the likely benefits or requirements for an alternative antibiotic. These include the genetic differences in the drugs controlling transport pathways or metabolizing drugs. While some may actually change the accumulation of azithromycin across the urinary system or its total clearance rate. This approach takes the treatment approach to a whole new level—the one prescribed and decided by clinicians—by reducing cases of ineffective treatment, side effect occurrence, or the development of antibiotic resistance.
Conclusion
Azithromycin is one of the other antibiotics that have been used to treat various infections but not urinary tract infections. Its spectrum of activity does not cover the most common pathogens, more so E. coli, which causes UTIs; instead, it is supplemented by antibiotics that should be used in treating UTIs, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fluoroquinolones. However, it could still be used a few times due to rare or co-infectious pathogens. However, it does not act as the first drug used in the case of UTI.
Always seek a healthcare provider for a proper diagnosis and appropriate treatment for the UTI; an untreated infection can cause several complications, including kidney damage.
References
https://medisearch.io/blog/can-azithromycin-treat-a-uti
https://www.mdsaude.com/en/nephrology/treatment-of-urinary-tract/
https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2020.542755/full
FAQs
Azithromycin is not usually given for UTI infections because the antibiotic does not respond effectively to most pathogens responsible for UTIs, such as E. coli. For UTIs, other drugs like nitrofurantoin or ciprofloxacin are commonly administered.
This is only reserved for cases with rare causative agents, as in Chlamydia trachomatis or Mycoplasma genitalium, or even with a co-infection such as chlamydia. In reality, this does not commonly occur, and the antibiotic should be selected based on the result of urine cultures.
PGx testing can determine how a person’s genetic makeup affects their response to azithromycin so that healthcare providers can select the most effective antibiotic based on the patient’s genetic profile. This will avoid ineffective treatment and reduce the risk of resistance.
First-line antibiotics for UTIs include trimethoprim-sulfamethoxazole (Bactrim), nitrofurantoin (Macrobid), and fluoroquinolones (such as ciprofloxacin). These antibiotics are more effective against E. coli, the most common cause of UTIs.
Yes, overuse or inappropriate use of azithromycin can contribute to antibiotic resistance. This is particularly concerning in treating UTIs, where resistance can make future infections harder to treat and limit available treatment options.
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