What does it mean if your UTI symptoms are getting worse even though you’ve already taken four or six antibiotic pills?

Does this mean you don’t have a urinary tract infection after all, but some other condition?

And is it just a coincidence that the urinalysis showed trace amounts of bacteria and leukocyte esterase?

“UTI’s may get worse while taking an antibiotic for several reasons,” says Michael Ingber, MD, board certified in urology, female pelvic medicine and reconstructive surgery, and founder of The Center for Specialized Women’s Health, division of Garden State Urology.

“First, it does take some time, typically several hours, before the antibiotic is absorbed into the system and before it gets into the bladder,” continues Dr. Ingber.

“Second, the antibiotic sometimes may not be effective. In cases of resistant UTI, symptoms may worsen.

“This is why, typically, I instruct women to contact me should their symptoms persist or worsen after 2-3 doses of the antibiotic.”

Thus, no improvement after only one day is nothing to fret about.

But what about a worsening of your symptoms three days into the antibiotic course?

“Well, it’s possible that symptoms are bad enough, or an infection is bad enough, that it will take three to four days for things to clear up,” says Dr. Ingber.

“However, usually, if it’s a simple UTI (bladder infection), we only use three days total of most antibiotics (five if Macrobid).”

Macrobid is the brand name for the antibiotic nitrofurantoin. This drug may take a little longer than the three-day antibiotics to start turning back the symptoms.

“So symptoms REALLY should be better after one to two days, because day three would be the last day of abx [antibiotics],” says Dr. Ingber.

“In the more rare case of bacterial spread to the kidneys (pyelonephritis), it may take 5-7 days for symptoms to get better.

“However, we typically know this to start — e.g., patients have fevers, severe back/flank pain, and we would give seven days of abx to start.”

Dr. Ingber is board-certified in Urology and Female Pelvic Medicine & Reconstructive Surgery; is a Fellow of the International Society for the Study of Women’s Sexual Health. The Center for Specialized Women’s Health, division of Garden State Urology & Atlantic Medical Group.
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Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer. 



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