Is Doxycycline Good for UTI? Everything You Need to Know

If you’re suffering from a urinary tract infection (UTI), you’re probably looking for a quick and effective treatment. One medication that is often prescribed for UTIs is doxycycline. But is doxycycline good for UTI? In this blog post, we’ll explore the effectiveness of doxycycline for UTI treatment and how Nao Medical can help you get rid of your UTI quickly and easily.

What is Doxycycline?

Doxycycline is an antibiotic medication that is used to treat a variety of bacterial infections, including UTIs. It works by preventing the growth and spread of bacteria in the body.

Is Doxycycline Effective for UTI Treatment?

Yes, doxycycline can be effective for treating UTIs. However, it is not always the first choice of medication for UTI treatment. Your healthcare provider will determine the best course of treatment for your specific case of UTI.

It’s important to note that doxycycline is not effective against all types of bacteria that can cause UTIs. In some cases, your healthcare provider may need to prescribe a different antibiotic medication to effectively treat your UTI.

How Does Nao Medical Treat UTIs?

At Nao Medical, we offer a variety of services to help you get rid of your UTI quickly and easily. Our experienced healthcare providers can diagnose your UTI and determine the best course of treatment for your specific case.

We offer same-day appointments, minimal wait times, exceptional and empathetic staff, stunning clinic environments, a technologically driven approach with a comprehensive app, and extensive after-hours virtual care. We also offer a variety of other healthcare services, including urgent care, primary care, multi-speciality care, mental health, women’s health, nutrition services, and more.

FAQs

Is doxycycline the best medication for UTI treatment?

Not always. Your healthcare provider will determine the best course of treatment for your specific case of UTI.

What are the common side effects of doxycycline?

Common side effects of doxycycline include nausea, vomiting, diarrhea, and skin rash.

How can I prevent UTIs?

You can help prevent UTIs by drinking plenty of water, urinating frequently, wiping from front to back after using the bathroom, and avoiding irritating feminine products.

Key Takeaways

• Doxycycline can be effective for treating UTIs, but it is not always the first choice of medication.
• Your healthcare provider will determine the best course of treatment for your specific case of UTI.
• Nao Medical offers a variety of services to help you get rid of your UTI quickly and easily.

Don’t suffer from a UTI any longer. Book an appointment with Nao Medical today to get the best treatment for your UTI!

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Disclaimer: The information presented in this article is intended for general informational purposes only and should not be considered, construed or interpreted as legal or professional advice, guidance or opinion.

Doxycycline: Uses, Side Effects, Dosage

Doxycycline is a versatile antibiotic used to treat bacterial infections, acne, and more.

This article provides information about the uses, common side effects, proper dosage, and risks of this widely used medication.

What is Doxycycline?

Doxycycline is a frequently usedtetracycline antibiotic.

Tetracyclines can be used to treat infections that are caused by bacteria that are both gram-positive and gram-negative, as well as many other common bacteria types.

Tetracyclines kill bacteria by interfering with their ability to grow.

Tetracyclines are commonly used for many different bacterial infections, including skin infections, sexually transmitted infections (STIs), and even malaria.

Doxycycline is available only by prescription.

It is available in a generic formulation as well as under different brand names, including Morgidox, Doryx, Acticlate, and Avidoxy.

Doxycycline may be prescribed as a capsule, poweder, or in liquid form.

It’s always important to follow the specific instructions on your prescription, as they can vary based on the formulation and dosage that you are prescribed.

If you are prescribed doxycycline, be sure to complete the full course of the antibiotics unless your doctor specifically tells you to stop.

If you don’t complete your prescription, the antibiotics may not fully treat your bacterial infection and may increase your risk of antibiotic resistance. 

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Why is Doxycycline Prescribed?

There are many FDA-approved uses for doxycycline.

Your doctor may prescribe it for any of the following common reasons.

It’s also possible that your health care provider may prescribe it for other reasons not listed here.

If you have questions about why a medication is prescribed, ask your doctor or pharmacist.

Acne

Severe, persistent acne or other skin issues such as rosacea or acne vulgaris that are resistant to other treatment are often treated by dermatologists with tetracycline antibiotics, including doxycycline.  

Urinary tract infections

While rarely the initial choice, Doxycycline can be used to treat urinary tract infections (UTIs).

Most urine samples are cultured to ensure that the correct antibiotic is used.

Doxycycline has advantages because it has broad-spectrum antimicrobial activity and can concentrate effectively in the urine to prevent bacterial replication.

It has lower levels of toxicity than other types of antibiotics and may also be used in some cases to treat multidrug-resistant UTIs that are caused by E. coli or Klebsiella pneumoniae.

Intestinal infections

Intestinal infections can be caused by viruses or bacteria.

If a gastrointestinal illness is determined to be caused by bacteria, it might be treated with doxycycline.

Bacterial gastroenteritis is sometimes referred to as food poisoning.

Contamination can happen from food sources like raw meats, lettuce, poultry, eggs, or dairy, as well as from ingesting contaminated water.   

Respiratory infections

Doxycycline may be used to treat bacterial pneumonia because doxycycline can concentrate in lung tissues, it is especially effective at treating respiratory infections.

Eye infections

In addition to being an antibacterial, doxycycline also exerts an anti-inflammatory effect, making it a good antibiotic for eye infections.

This may help to reduce irritation and keep the eye’s delicate tissues from scarring or otherwise being damaged by ocular bacterial infections.

Doxycycline is effective against eye infections like chlamydial conjunctivitis, which often co-occurs with a genital infection.

It may also be prescribed for severe blepharitis or Meibomian gland dysfunction.

Sexually transmitted infections (STIs)

Sexually transmitted infections (STIs) can be treated with doxycycline.

It may be prescribed for chlamydia, syphilis, and pelvic inflammatory disease, among others.

It works to systematically reduce inflammation and to prevent the replication of bacteria.

Doxycycline may also be used prophylactically to prevent or decrease the risk of developing a STI, like chlamydia or syphilis, though its usage in this context should be carefully discussed with your doctor.

Periodontitis (gum disease)

Doxycycline can be used to treat periodontal disease, which is an infection of the gums.

Doxycycline is effective for periodontitis due to its ability to reduce activity of proteins that affect gum tissue without otherwise destroying normal beneficial oral bacteria.

Malaria

Doxycycline is widely used for malaria both as prophylaxis and as treatment.

For prevention, it is often paired with chloroquine and taken at lower doses for 1-2 days before a trip and during the course of travel.

When treating malaria infections, it is combined with other drugs like quinine or quinidine.

Doxycycline Side Effects

Doxycycline has some common side effects.

They may include:

• Nausea
• Vomiting
• Loss of appetite
• Diarrhea
• Rectal or vaginal itching
• Sore throat
• Swollen tongue
• Dry mouth
• Back pain
• Changes to the color of skin, scars, nails, eyes, or mouth
• Anxiety

Other side effects, which are less common but might be more severe, could include:

• Headache
• Vision changes like blurry vision, double vision, or loss of vision
• Hives, rash, or other allergic reactions
• Skin redness, blistering, or peeling
• Fever
• Swollen glands
• Difficulty breathing or swallowing
• Swelling of the eyes, lips, throat, tongue, or face
• Unusual bleeding or bruising
• Changes to bowel movements, including watery or bloody stools
• Stomach cramps
• Joint pain
• Chest pain
• Discoloration of permanent teeth
• Jaundice
• Dark urine

You should call your doctor if you notice any of these side effects, or if you develop any other new or concerning symptoms.

Use of doxycycline in young children under age 12 is not advised because it can cause tooth discoloration and may impact bone development.

Rarely, it may also lead to brain swelling children.

It should also not be used during pregnancy, breastfeeding, or if you are allergic to tetracycline antibiotics.

How to Take Doxycycline

Your pharmacist will provide you with instructions on how to take your doxycycline prescription.

Be sure to read your prescription label and follow the instructions.

Call your doctor or pharmacy if you have any questions.

Doxycycline can come in different forms and doses, so be sure to follow the specific instructions on your prescription.

It is typically prescribed either once per day or twice per day.

If you take it two times per day, be sure to take the medication 12 hours apart.

What happens if I miss a dose?

If you miss a dose of doxycycline, take it as soon as you realize that you have missed it.

However, if your missed dose is close to your next dose, simply skip it and continue your schedule.

Do not take two doses close together.

What happens if I take too much?

If you take too much doxycycline, call poison control at 1-800-222-1222 or seek emergency medical care.

You should not take double doses or more doxycycline than is prescribed.

If someone has taken too much doxycycline and they have trouble breathing, collapse, or have a seizure, call 911 immediately for medical help.

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What to Avoid While Taking Doxycycline

Doxycycline has many drug interactions.

Don’t change what you are taking without checking with your doctor or pharmacist.

That includes other medications or supplements, as well as over-the-counter drugs.

Iron, calcium, and magnesium supplements should not be taken within two hours of taking doxycycline.

It is important to stay hydrated while taking doxycycline.

Drink plenty of fluids when you take your medicine and throughout the day.

Do not take doxycycline with dairy products, since they may prevent your body from absorbing the medicine.

If you do plan on eating milk, cheese, yogurt, or other dairy products, have them either a few hours before or after taking doxycycline.

Ask your doctor or pharmacist if it is acceptable to consume alcohol while taking doxycycline.

Some research shows that regular alcohol consumption may decrease the effectiveness of the medication or may require higher doses.

Alcohol may also reduce the medication’s ability to do its job, making it harder to reduce bacteria.

Most medical advice recommends avoiding alcohol during antibiotics.

Avoid prolonged sun exposure while taking doxycycline, because it causes temporary skin sensitivity and can increase your risk for sunburn.

If you must be in the sun, wear protective clothing and be sure to use sunscreen.

How K Health Can Help

Do you have questions about your doxycycline prescription?

Did you know you can get affordable primary care with the K Health app? Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a provider in minutes. K Health’s AI-powered app is based on 20 years of clinical data.

Is doxycycline a strong antibiotic?

Doxycycline is an antibiotic that is frequently used for hard-to-treat infections or those that are resistant to other drugs. It works somewhat differently than other antibiotics, and its potency is determined by dosage and course of treatment.

What is doxycycline used for?

Doxycycline is used for many purposes as both an antibiotic and anti-inflammatory drug. It may be prescribed for acne, sexually transmitted infections, malaria, eye infections, gastrointestinal infections, and more.

What is doxycycline used for most?

Doxycycline is used for common conditions like acne, rosacea, skin or eye infections, sexually transmitted infections, and more. It is beneficial because of its versatile ability to treat several types of bacteria without causing serious side effects.

What are the common side effects of doxycycline?

The most common side effects of doxycycline are similar to those of other antibiotics: stomach upset, loss of appetite, vomiting, changes to bowel movements, dry mouth, and more. It may increase anxiety in some. Read the insert of your prescription to learn more about side effects or speak with your doctor or pharmacist if you have concerns.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Doxycycline. (2017).
  https://medlineplus.gov/druginfo/meds/a682063.html

• Oral Doxycycline in the Management of Acne Vulgaris: Current Perspectives on Clinical Use and Recent Findings with a New Double-scored Small Tablet Formulation. (2015).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445892/

• Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection. (2017).
  https://pubmed.ncbi.nlm.nih.gov/27071978/

• Bacterial gastoenteritis. (n.d.).
  https://medlineplus.gov/ency/article/000254.htm

• Use of Oral Tetracyclines in the Treatment of Adult Patients with Community-Acquired Bacterial Pneumonia: A Literature Review on the Often-Overlooked Antibiotic Class. (2020). ​
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7764829/

• Pharmacological basis for the potential role of Azithromycin and Doxycycline in management of COVID-19. (2021).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797177/

• Doxycycline, an antibiotic or an anti-inflammatory agent? The Most Common uses in dermatology. (2020).
  https://www.sciencedirect.com/science/article/pii/S1578219020301980

• Common eye infections. (2018).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003010/

• Comparison of therapeutic effects of topical azithromycin solution and systemic doxycycline on posterior blepharitis. (2016).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951657/

• Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series. (2019).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446637/

• Doxycycline hyclate. (2021).
  https://www.ncbi.nlm.nih.gov/books/NBK555888/

• Doxycycline. (2021).
  https://pubchem.ncbi.nlm.nih.gov/compound/Doxycycline

• Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections. (2020).
  https://academic.oup.com/cid/article/70/6/1247/5557867

• Doxycycline for Malaria Chemoprophylaxis and Treatment: Report from the CDC Expert Meeting on Malaria Chemoprophylaxis. (2011).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062442/

• Questions and answers for consumers on doxycycline. (2018).
  https://www.fda.gov/drugs/bioterrorism-and-drug-preparedness/questions-and-answers-consumers-doxycycline

• Doxycycline. (2018).
  https://www.nhs.uk/medicines/doxycycline/

• Fact versus Fiction: a Review of the Evidence behind Alcohol and Antibiotic Interactions. (2020).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038249/

• Efficacy of doxycycline as a combination therapy in the treatment of rheumatoid arthritis: a randomized controlled clinical trial. (2021).
  https://ejim.springeropen.com/articles/10.1186/s43162-021-00032-5

• Clinical Outcomes of Early Treatment With Doxycycline for 89 High-Risk COVID-19 Patients in Long-Term Care Facilities in New York. (2020).
  https://www.cureus.com/articles/37354-clinical-outcomes-of-early-treatment-with-doxycycline-for-89-high-risk-covid-19-patients-in-long-term-care-facilities-in-new-york

Taking alcohol and antibiotics at the same time

Alcohol and antibiotics. Many people think that this combination is dangerous. What are the real risks of drinking while on antibiotic treatment?

Please note that the article contains the names of the active ingredient of antibiotics, trade names may be different.

When a person drinks, ethanol is converted to acetaldehyde. For some, this substance causes nausea.

Antibiotic therapy may cause gastrointestinal side effects. Alcohol intake during treatment can increase the manifestation of side effects, increasing nausea and general weakness.

The table shows commonly prescribed antibiotics, their compatibility with alcohol and the result of mixing antibiotics with alcohol

9 0164

How do doxycycline and minocycline interact with alcohol?

Tetracyclines include doxycycline and minocycline. Many bacterial infections, including sexually transmitted infections, are treated with these drugs. In addition, doxycillin is used to prevent Lyme disease (Lyme borreliosis) after a tick bite. You can not drink alcohol when taking doxycycline: the drug interacts with alcohol, the removal of the antibiotic from the body is accelerated and it does not have the expected therapeutic effect.

The interaction of minocycline with alcohol increases the toxic effect of the drug on the liver.

How linezolid interacts with alcohol

Linezolid belongs to the class of oxazolidinone antibiotics. Doctors prescribe oxazolidinones to treat infections in the abdomen, skin, lungs, and urinary tract.

In addition to its antibacterial effect, linezolid reduces the action of enzymes called monoamine oxidase-A and monoamine oxidase-B. Monoamine oxidases break down tyramine. Tyramine is found in draft beer and red wine.

When people drink draft beer or red wine while being treated with linezolid, the amount of tyramine in the blood may increase. The following side effects appear: increased sweating, frequent pulse, fever, change in mental state, vomiting, heart rhythm disturbances, increased blood pressure, convulsions. This is due to the interaction of the drug not with ethanol, but with tyramine.

How sulfonamides interact with alcohol

Doctors prescribe sulfonamide antibiotics to treat urinary, respiratory, and abdominal infections. Sulfonamide antibiotics include sulfamethoxazole and trimethoprim, available under various trade names.

Sulfamethoxazole and trimethoprim interfere with folic acid metabolism in bacteria. Trimethoprim in rare cases can also affect the metabolism of folic acid in human cells. With a deficiency of folic acid in the body, the simultaneous use of alcohol with sulfonamide preparations leads to a further decrease in it.

The dangers of combining fluoroquinolones with alcohol

In 2018, the US Food and Drug Administration (FDA) published updated safety warnings for all fluoroquinolone antibiotics.

Labeling of all fluoroquinolones now highlights possible mental health side effects of the drug. These side effects may include: attention disturbances, disorientation, nervousness, memory loss, confusion.

Mixing alcohol with fluoroquinolone antibiotics may increase these mental health side effects.

Nitroimidazoles and alcohol

Metronidazole is a nitroimidazole antibiotic that doctors prescribe to treat abdominal infections, sexually transmitted infections.

Metronidazole interferes with the function of a key enzyme that helps the body digest alcohol. When metronidazole inhibits the enzyme aldehyde dehydrogenase, the concentration of toxic acetaldehyde in the blood accumulates. This enhances the toxic effects of alcohol.

Mixing alcohol with metronidazole may cause: abdominal cramps, nausea, vomiting, headaches, facial flushing.

People should avoid alcohol during treatment with metronidazole and for 3 days after the last dose.

Effect of alcohol on the immune system

Drinking alcohol adversely affects the immune system. People who abuse alcohol are more likely to become infected with viral and bacterial infections, recover longer and recover from illness. Alcohol addiction treatment is recommended for people with alcohol dependence.

Dynamics of antibiotic resistance in urological patients uMEDp

Relevance . Over the past few years, approaches to the classification and treatment of urinary tract infections have changed. One of the reasons for the growth of antibiotic-resistant flora and the recurrence of urinary tract infections is the violation of the principles of rational antibiotic therapy in urology.
Purpose of study : to study the microbial spectrum of urine in major urological diseases and the resistance of the flora to the most commonly used antimicrobial drugs.
Material and methods . A retrospective and prospective analysis of the results of urine culture (14,321 samples) from 2011 to 2018 was performed with the determination of the sensitivity of the flora to antibacterial drugs. It turned out that the frequency of isolation of Escherichia coli, which used to be the leader in the structure of pathogens of urinary tract infections, decreased by half, amounting to only 33.5% of the total number of detected microorganisms, and the proportion of conditionally pathogenic flora increased from 5.3 to 17.1% . The second place in terms of the frequency of detected flora was taken by microorganisms of the genus Staphylococcus . Antibacterial therapy prescribed without taking into account specificity and sensitivity in 4% of cases caused recurrence of upper urinary tract infections. The resistance of microorganisms to penicillins and second-generation cephalosporins was noted. In addition, the importance of fluoroquinolones and third-generation cephalosporins as drugs that have a positive antibacterial effect in the treatment of urinary tract infections has decreased. The sensitivity of microorganisms to nitrofurantoin remained at the same high level.
Pins . The study showed a change in the structure of pathogens of urinary tract infections. Initiation of antibiotic therapy before urinalysis explains the low incidence of bacteriuria. Short-term courses of antibiotic therapy without taking into account the sensitivity of microorganisms lead to an increase in the proportion of forms of bacteria resistant to antimicrobial drugs. Thus, at the outpatient stage, the principles of rational antibiotic therapy are not observed and the results of antibioticograms are not monitored.

Table 1 Gram-positive urine flora, abs. (%)

Table 2 Gram-negative flora of urine, abs. (%)

Fig. 1. Dynamics of the sensitivity of microorganisms to antibacterial drugs

Fig. 2. Dynamics of resistance of microorganisms to antibacterial drugs

Relevance

Urinary system infections are among the most common diseases in outpatient and hospital practice [1, 2]. The microbial landscape in each medical institution is the result of complex processes of interspecies relationships between micro- and macroorganisms, taking into account the influence of various environmental factors [3]. Bacteria are constantly subjected to selective pressure from chemical agents, such as antibiotics [4]. The structure of microorganisms is changing and resistance to antibacterial drugs is growing, which becomes one of the reasons for the ineffectiveness of etiotropic treatment [5].

Asymptomatic bacteriuria accompanies urological and non-urological patients. Generally accepted urological recommendations determine the procedure for the treatment of asymptomatic bacteriuria only in two cases: in pregnant women and patients before surgery [6]. At the same time, without medical invasive manipulations, the infectious process can become chronic or affect neighboring organs [7].

Patients’ attempts to self-treat urinary tract infections (due to the availability of antibacterial drugs) increase the risk of disease progression or lead to the formation of antibiotic-resistant forms of bacteria [8].

When choosing an antibiotic, doctors should take into account not only the causative agent of the disease, but also the spectrum of action of the drug, its pharmacokinetic and pharmacodynamic profile, undesirable side effects, which is not always performed in outpatient and inpatient practice [9].

According to the scientific literature, currently the main microbial agent of urinary tract infections, which occurs with a frequency of 75–95%, is Escherichia coli [10]. Our analysis made it possible to identify changes in the structure of pathogens of urinary tract infections and show the development of microbial antibacterial resistance in dynamics.

Purpose of study

To study the microbial spectrum of urine in the main urological diseases and reflect the dynamics of antibiotic resistance.

Material and methods

A retrospective and prospective analysis of the data of the Working Journal of Microbiological Research (Form 253/y) and the Journal of Registration of Studies and the Results of Establishing the Susceptibility of Microorganisms to Chemotherapeutic Drugs (Form 254/y), approved by orders of the Ministry of Health of the USSR dated 04.10.19, was performed.80 No. 1030 and dated April 22, 1985 No. 535, respectively. Data from 2011 to 2015 were retrospectively evaluated, and data for 2016–2018 were evaluated prospectively.

The results of a microbiological study of urine (a total of 14,321 samples) of patients who were on outpatient and inpatient treatment in the institutions of the city of Saransk of the Republic of Mordovia and received a referral to study the microbial landscape and determine the sensitivity of microorganisms to the bacteriological department of the Republican Clinical Hospital No. 4 of the city of Saransk were analyzed.

Material sampling and transportation were carried out in accordance with GOST R 53079.4-2008 “Clinical laboratory technologies. Ensuring the quality of clinical laboratory research. Part 4. Rules for conducting the preanalytical stage. Verification of laboratory strains of microorganisms was carried out by bacteriological methods according to classical methods on the basis of the order of the Ministry of Health of the USSR dated 04/22/1985 No. 535, SP 1.2.036-95, FZ dated 03/30/1999
No. 52-FZ (as amended). To study the sensitivity of microorganisms to traditional antimicrobial drugs, the disk diffusion method MUK 4.2.189 was used.0-04.

The results of the study are expressed in absolute and relative units. Taking into account the fact that the elements of the study are descriptive in nature, the data obtained do not belong to the nominal and ordinal system of measurement, and the age of patients is presented as a separate categorical feature, the statistical evaluation of the data obtained was not performed. The calculation of values, the construction of graphical and tabular data for the types of microorganisms were carried out automatically using the Microsoft Excel 2010 program (Microsoft Corporation, USA), the research results were formatted in the Microsoft Word 2010 text editor (Microsoft Corporation, USA). The effectiveness of antibiotics was assessed by the diameter of the zones of no growth for individual crops. The results obtained were entered into the database for all the years of observation and evaluated using a nonparametric criterion – Kendall’s rank correlation coefficient (SPSS 16.0 program (SPSS Inc., USA)).

Results

Evaluation of the results of microbiological examination of urine (14,321 samples) made it possible to identify pathogens in 21% (n = 3780) of cases. In 79% (n = 10,541) of cases, pathogens were not identified, most likely due to the start of antibiotic therapy before the test. Repeated urine analysis to clarify the degree of bacteriuria after etiotropic therapy, taking into account sensitivity to antibiotics, was performed in 11% of patients, of which 8% were pregnant.

Most pathogens were found in the following age groups: under 18 years old (22.6%, n = 854), 25–44 years old (22.2%, n = 838) and 61–74 years old (22.2%, n = 840), which accounted for 67% of the total number of subjects. The remaining 33% are patients aged 18–24, 45–60 and 75–90 years old. Thus, there was an alternation of age periods for the detection of the maximum number of microorganisms in urine, due to a greater extent to social reasons. Among them, employment, observation in the prenatal period, the passage of a dispensary examination, the establishment of specific complaints and symptoms that require additional examination for bacteriuria.

Most often (77.9%, n = 2948), pathogens were detected in women aged 25–44 years with diagnoses of “acute recurrent cystitis” and “acute recurrent pyelonephritis”. In men, the maximum detection rate fell on the period from 61 to 74 years, which was explained by diseases of the lower urinary tract, combined with chronic urinary retention.

The most common (72%, n = 2722) reasons for examination were urinary tract infections of various locations: chronic pyelo-
nephritis (45.2%, n = 1709), acute pyelonephritis (6.2%, n = 234), acute pyelonephritis of pregnancy (12.9%, n = 488) and chronic cystitis (7.7%, n = 291 ).

Secondary chronic pyelonephritis was observed in 8.3% (n = 314) of men and 36.9% (n = 1395) of women. In women, with increasing age, the frequency of chronic pyelonephritis has steadily increased, reaching a peak (32%) at 61-74 years. In men, a maximum (5%) was recorded in the age group up to 18 years, which is due to a violation of urodynamics against the background of various corrected and uncorrected congenital anomalies in the development of the genitourinary system.

Before the start of therapy for acute pyelonephritis, the degree of bacteriuria was determined only in 6.2% (n = 234) of patients, of which 1.6% (n = 60) were men, 4.6% (n = 174) were women. In the remaining patients, outpatient and inpatient treatment was carried out without taking into account the degree of bacteriuria and the initial confirmation of the sensitivity of microorganisms found in urine to antibacterial drugs, which is contrary to the recommendations of the European Association of Urology. This is probably due to the mild and moderate severity of the disease, when the prescribed antibiotic therapy can have a significant clinical effect.

Repeated examination for microflora was carried out in 3.8% (n = 144) of cases (only those patients whose bacteriological examination of urine was performed before the start of therapy were taken into account). The reason for referral for analysis was the recurrence of acute pyelonephritis, which developed in 0.6% (n = 23) of men and 3.2% (n = 121) of women. In pregnant women with acute pyelonephritis who underwent a course of antibiotic therapy, in 8% (n = 302) of cases, subsequent analysis revealed bacteriuria, which was not accompanied by any clinical symptoms. In these women, the diagnosis of “asymptomatic bacteriuria” caused repeated hospitalization in the urological hospital.

Asymptomatic bacteriuria in general was noted in 17% (n = 643) of cases: in 6.1% (n = 231) of men and 10.9% (n = 412) of women. The following distribution among men depending on age was shown: 2. 8% (n = 107) in the group under 18 years old, 0.3% (n = 13) – 25-44 years old and 3% (n = 113) – 61 -74 years old. In women, asymptomatic bacteriuria was more common at the age of 61-74 years – 5.8% (n = 219), slightly less often – 3% (n = 112) – up to 18 years, and 2.1% (n = 80) of cases were distributed equally in all other age categories. 11% (n = 415) of patients diagnosed with “urolithiasis” and “fever of unknown origin” were referred for examination.

The microbial spectrum of urine is represented by numerous types of gram-positive (39.2%) (Table 1) and gram-negative (60.8%) (Table 2) microorganisms. The results obtained are combined into groups according to the genus and species of bacteria and are expressed in absolute and relative units to the total number of studies without taking into account the values ​​when the microorganism is not detected in urine cultures.

The results of the study refuted the classical idea of ​​ Escherichia coli as the main causative agent of urinary tract infections, since E. coli accounted for only 33.5% of all microorganisms, and in all age categories its frequency of occurrence did not exceed 10%. During the analyzed period, there was a gradual decrease in the proportion of Escherichia coli in the structure of inoculated urine microorganisms. The second place (18.5%) in terms of the frequency of detected flora was taken by microorganisms of the genus Staphylococcus , predominantly Staphylococcus epidermidis (12.4%). The third were gram-negative microorganisms of the genus Proteus (8.8%), of which 5.0% were Proteus mirabilis and 3.8% were Proteus vulgaris.

In the structure of all pathogens, the number of conditionally pathogenic microorganisms detected during urine examination increased three times from 2011 to 2018, increasing from 5.3 to 17.1% (gram-positive flora was 11.3%, and gram-negative – 5.8 %).

Analysis of the structure of microorganisms determined during urine cultures in patients with acute and chronic pyelonephritis revealed a predominance of Escherichia coli (15. 6%). Staphylococcus epidermidis (5.9%), conditionally pathogenic flora (3.2%) and other microorganisms (Enterococcus, Proteus mirabilis, Citrobacter freundii, Citrobacter diversus) were sown much less often – in total no more than 2.5%.

In patients with asymptomatic bacteriuria, Escherichia coli , in 25% – Staphylococcus epidermidis , in 23% – conditionally pathogenic gram-positive flora, in 11% – Enterococcus, Staphylococcus aureus, Citrobacter diversus, Proteus mirabilis. Patients with urolithiasis without signs of exacerbation of pyelonephritis were also examined. In 27.7% of cases, they had pathogenic flora: Staphylococcus epidermidis (11.2%), Escherichia coli (9%), opportunistic gram-positive flora (3%), other microorganisms (4.5%).

Thus, the number of cases of isolation of Escherichia coli in patients with suspected or obvious signs of urinary tract infections gradually decreased, and gram-positive and opportunistic microorganisms increased. It was established that not always identified microorganisms were the source of the infectious process. The change in the structure of microbial association in urological patients, according to our assumption, was due to the irrational use of antibiotics.

The sensitivity of microorganisms was determined taking into account the frequency of use of individual antibacterial drugs in clinical practice. Most often in hospitals, patients with urinary tract infections were prescribed ceftriaxone, amikacin, ampicillin, doxycycline, ciprofloxacin and imipenem, and outpatients – levofloxacin, amoxicillin, doxycycline, nitrofurantoin and ciprofloxacin. The construction of a normalized stacked chart for the sensitivity and resistance of microorganisms to antibacterial drugs is based on the frequency of occurrence of the trait and its share in the general category. The result is expressed as a percentage of each antibiotic, taking into account the frequency of its use in the general spectrum of sensitivity.

The data obtained demonstrated the high efficiency of imipenem, nitrofurantoin, amikacin, which practically did not decrease over the study period (Fig. 1). A decrease in the effectiveness of ampicillin and ciprofloxacin, as well as ceftriaxone and doxycycline, was registered. The frequency of antibiotic-resistant forms of microorganisms correlated with the ever-increasing inefficiency of ampicillin and cefuroxime (Fig. 2). During the study period, the resistance of strains to nitrofurantoin and imipenem remained at a low level. A gradual decrease in the effectiveness of levofloxacin and ceftriaxone was noted.

The reliability of the obtained graphic materials for nitrofurantoin, imipenem, ampicillin and ciprofloxacin was assessed by calculating the Kendall W coefficient. The relative decrease in the effectiveness of nitrofurantoin and imipenem, assessed using the Kendall W coefficient, revealed a sufficient relationship of all groups from 2011 to 2018 (Kendall W coefficient 0. 801, χ ² 78.112, p = 0.000), indicating the absence of a statistically significant difference between values. Efficacy of ampicillin and ciprofloxacin, assessed from 2011 to 2018 by Kendall W coefficient 0.135, χ ² 67.432, p = 0.001, shows a significant difference between the obtained values.

Thus, the empirical use of ampicillin and ciprofloxacin in the treatment of urinary tract infections is insufficiently substantiated. The high efficacy of nitrofurantoin and imipenem is maintained. Further monitoring of antibiograms will reveal the dynamics of the growth of resistance of microorganisms to other antibacterial drugs.

Discussion of results

The concept of urinary tract infections has changed dramatically over the past few years. New classifications, approaches to diagnosis and treatment are largely due to the ineffectiveness of the therapy. The availability of antibacterial drugs, often their uncontrolled unreasonable prescription and use have led to a change in the structure of the microbial spectrum, sown in the study of the microbiota of urine.

It should be noted the importance of the formation of antibiotic-resistant forms of microorganisms in the recurrence and progression of the infectious process. Decreased role Escherichia coli as the main causative agent of urinary tract infections – according to our data, it accounted for no more than 33.5% of the total number of detected microorganisms. The representation of gram-positive flora, which causes frequent recurrence of the infectious process, has increased. Conditionally pathogenic gram-positive and gram-negative bacteria began to be detected more often in patients with urinary tract infections. An important question remains whether the detected flora is the source of the inflammatory process.

An analysis of the sensitivity of microorganisms to antibiotics used in routine practice demonstrated the ineffectiveness of second-generation penicillins and cephalosporins as drugs that have an antibacterial effect in the treatment of urinary tract infections.