Urinary tract infections (UTIs) are miserable. They burn. They interfere with our most basic bodily functions. They can spread to our kidneys. And they often come back, again and again. 60% of women and 12% of men will develop at least one UTI in their lifetime. In fact, UTIs are both the most common hospital acquired infection and the most common outpatient infection. Because of this, UTIs are an economic burden in terms of healthcare costs and missed workdays and are a leading cause of antibiotic prescriptions. 

We’ve been fighting UTIs (also known as cystitis) with the same antibiotics for twenty years, so the bacteria that causes UTIs have gotten used to our old arsenal and have become somewhat antibiotic resistant. That’s why it is big news that the FDA has approved the first new antibiotic in two decades designed to fight uncomplicated UTIs. Even better, a second new UTI antibiotic is showing great results in late-stage clinical trials. 

Here’s what you need to know.

What is an “uncomplicated UTI?” 

Uncomplicated UTIs are lower urinary tract infections in either men or non-pregnant women who are otherwise healthy. On the other hand, complicated UTIs are associated with risk factors that increase the likelihood and severity of the infection or the chances of failing antibiotic therapy. These risk factors could include diabetes, a suppressed immune system, recurrent UTIs, and even pregnancy. 

How did the bacteria that cause UTIs become resistant to antibiotics? 

There are several factors that have contributed to the growing resistance of UTIs to traditional antibiotics, but they all boil down to simple evolution.  

1. Widespread use of antibiotics: Bacteria that are exposed to antibiotics frequently are more likely to develop resistance. Contrary to popular belief, this does not necessarily mean antibiotics have been over-prescribed. Instead, some antibiotics are often-prescribed because they treat common infections. Over time, the bacteria “learn” the nature of the drugs and evolve into strains that are resistant to that antibiotic’s ability to treat the infection. This is further facilitated by the increased use of antibiotics by farmers to keep their livestock healthy. 
2. Incomplete treatment courses: Many patients don’t finish their full course of antibiotics, but stop due to side effects, such as intestinal problems, or because they are feeling better. So, once the miserable UTI symptoms subside, patients often just stop taking the antibiotic. This allows some bacteria, already exposed to the treatment but still alive, to develop resistance in the same way that some vaccines help our bodies develop resistance to disease. 
3. Global travel: The ability of people and goods to move easily from one part of the world to another can facilitate the spread of resistant bacteria across borders and continents. 

What’s different about the new medications? 

The medication approved last month by the FDA is called Pivya (pivmecillinam), but it isn’t really new. In fact, it has been used in Europe and Canada to treat UTIs for years. Unlike the traditional antibiotics used in the US to treat UTIs, Pyvia is a narrow-spectrum drug. That means it only works well against very specific types of bacteria that commonly cause UTIs, in this case, E. coli, Proteus mirabilis, and Staphylococcus saprophyticus. Since this medication only treats infections caused by specific bacteria, it hasn’t created antibiotic resistance, which is how Utility Therapeutics, the company that owns Pivya, knew there would be a market for this drug in the US. 

The medication on the horizon is called gepotidacin (it doesn’t have a short brand name yet). Gepotidacin is a new type of drug that treats antibiotic resistant UTIs, and it works by a novel mechanism that inhibits bacterial DNA replication. Bacteria evolve through replication, so by impeding its ability to replicate, gepotidacin makes it very difficult for the bacteria to develop resistance. GSK, the pharmaceutical company developing gepotidacin, is expected to submit it for FDA approval by the end of the year.  

What does all this mean to me? 

Chances are you, or a loved one, will develop a UTI (or experience a recurrent UTI) in the future, so it should be comforting to know that we have better ways to fight them. Also, understanding how bacteria become resistant to antibiotics may inform some of your behavior going forward. For example, you may want to seek out antibiotic-free meat and eggs. And always finish your entire course of antibiotics, for any infection, even if you are feeling much better. 

Some bonus tips on avoiding UTIs include: 

• Stay hydrated: Drinking plenty of fluids, especially water, helps to dilute your urine and ensures that you’ll urinate more frequently. This allows bacteria to be flushed from your urinary tract before an infection can begin. 

• Urinate as soon as you feel the urge: Avoid holding urine for long periods of time. It’s important to urinate regularly and when the urge arises, as retaining urine in your bladder can give bacteria a place to grow. 

• Use the bathroom after intercourse: Urinating soon after intercourse helps to flush out bacteria that may have entered the urethra during sexual activity. 

• Wear loose, natural fibers against your skin:  Wearing loose-fitting clothing and cotton underwear allows air to keep the urethra dry, decreasing the potential for bacteria to multiply.