Up-to-date OTC guidance. Mange uncomplicated acute UTI symptoms with hydration, phenazopyridine for temporary symptom relief, and supportive measures like heating pads or NSAIDs for discomfort. If symptoms persist beyond 48 hours or risk factors are present, seek medical attention for antibiotics. Avoid self-treatment if risk factors such as fever, flank pain, or immunosuppression are present.
January 10, 2025

Urinary Tract Infections: 2025 Updates

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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The self-reported annual incidence of urinary tract infection (UTI) is 11% in women and 3% in men. 12 UTIs are most common in women between 18 and 29 years of age. 

Antibiotics are first-line treatments for UTIs because of risk of progression to a kidney or more widespread infection; however, absolute risk is low for most people (1.43% with and 0.46% without antibiotics). According to a 2024 evidence review in American Family Physician and the 2018 UK National Institute for Health and Care Excellence (NICE) Guidelines, due to increasing microbial resistance to antibiotics, delaying immediate antibiotics may be considered for low-risk patients. See below for what you can do at home.

Seek medical attention for antibiotics and do not try to self-treat a UTI if you have any of the following risk factors:

  • Male sex

  • Abnormality of the urinary tract

  • Fatigue or malaise

  • Fever, chills, tachycardia

  • Flank pain, costovertebral angle tenderness

  • Immunosuppression

  • Nausea, vomiting

  • Permanent bladder catheter or use of a bladder catheter within the past two weeks

  • Pregnancy

If you are a woman with uncomplicated acute UTI symptoms (none of the above risk factors), you can consider at-home symptomatic treatment for 48 hours: 

First-Line Recommendations:

  • Hydration: Drinking plenty of water helps flush bacteria out of the urinary tract. Aim for at least 1.5 liters of water per day unless otherwise directed by a healthcare provider. Limit caffeine, alcohol, and citrus juices, which can irritate the bladder and exacerbate symptoms.

  • Phenazopyridine: An OTC urinary analgesic that does not treat UTI but provides temporary relief of discomfort, burning, and urgency. 100 mg orally three times daily after meals for up to two days (not to exceed this duration without consulting a healthcare provider. May cause orange or red discoloration of urine, which is harmless but noticeable. Phenazopyridine 99.5mg tablet (FDA unevaluated but used since before 1938).

Additional symptom relief:

  • Heating pad: Use a heating pad or hot water bottle on the lower abdomen to relieve discomfort. This can be used intermittently as needed for pain relief. Hot water pad with knitted cover

  • NSAIDs: Ibuprofen 200mg softgels (FDA N021472) can reduce inflammation and pain. Dose: 200–400 mg orally every 6–8 hours as needed (do not exceed daily maximum listed on the package). Naproxen 220mg caplets (ANDA 204872): An alternative for longer-acting pain relief. Dose: 220 mg orally every 8–12 hours (do not exceed daily maximum).

Prevention:

  • Adequate fluid intake: At least 1.5 L per day helps to flush out bacteria from the urinary tract. Women are at higher risk due to a shorter distance from the bladder to the outside of the body.

  • Cranberry juice or supplements: Reduces the adherence of bacteria (e.g., E. coli) to the bladder wall, potentially lowering infection risk. Use unsweetened cranberry juice or standardized supplements. Evidence is mixed but leans toward being effective, this is a safe adjunct for prevention. Concentrated cranberry supplement. 

Not recommended:

  • Lactobacillus-containing probiotics: Theoretically may help restore the normal vaginal and urinary microbiota, reducing the recurrence of UTIs. Current evidence does not not support this.

  • D-Mannose: Theoretically may prevent bacterial adhesion to the bladder lining and help reduce symptom severity or prevent recurrence. Current evidence does not not support this.

Prescription Medications

  • Antibiotics: For confirmed bacterial UTIs, first-line prescription antibiotics may include nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin. A healthcare provider will tailor treatment based on symptoms, bacterial resistance patterns, and patient factors.

Citation

Kurotschka, P. K., Gágyor, I., & Ebell, M. H. (2024). Acute Uncomplicated UTIs in Adults: Rapid Evidence Review. American Family Physician, 109(2), 167-174.

NICE guideline [NG109]. Urinary tract infection (lower): antimicrobial prescribing. Published: 31 October 2018.

Scott AM, Clark J, Mar CD, et. al.: Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis. Br J Gen Pract 2020; 70: pp. e200-e207.

Williams G, Stothart CI, Hahn D, et. al.: Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2023

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