International Journal of Research in Pharmacy and Allied Science

ISSN: 2583-6544   |  Issues per year: Monthly  |   Indexed In: Google Scholar, CORE, ScienceOpen, Researchgate

ISSN:2583-6544

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Evidence-Based Management of Urinary Tract Infections: Balancing Efficacy, Safety, and Antimicrobial Stewardship

Author(s): Fadilullahi Opeyemi Ibiyemi¹*1, Deborah Awoniran²2, Anthony Godswill Imolele²3, Ismail Kolawole Odetayo³4, Lawal Fatimah Ayomide³5

Email(s): 1ibiyemi.ademola97@gmail.com

Address:

    11. Department of Chemistry & Industrial Chemistry, Osun State Water Regulatory Commission, Ministry of Water Resources, Osun State, Nigeria 2. Miami University Ohio, Zip code: 45056-1846, United State of America
    2Ambrose Alli University, Ekpoma, 310104, Edo, Nigeria 3. Department of Biochemistry & Industrial Chemistry Fountain University, P.M.B. 4491 Osogbo Osun State, Nigeria
    Babcock University, Ogun State, Nigeria

Published In:   Volume - 4,      Issue - 10,     Year - 2025

DOI: https://doi.org/10.71431/IJRPAS.2025.41003  

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ABSTRACT:
Urinary tract infections (UTIs) are some of the most prevalent infectious diseases around the globe, affecting about 150 million people every year and putting a considerable strain on healthcare systems, both financially and clinically. This comprehensive review takes a closer look at the current landscape of UTI treatment, shining a light on first-line antimicrobial agents like nitrofurantoin, trimethoprim-sulfamethoxazole, and fosfomycin, as well as alternative options such as fluoroquinolones, beta-lactams, aminoglycosides, and carbapenems. The review dives into how these treatments function, their effectiveness, and the emerging patterns of resistance, particularly the growing concern of antimicrobial resistance in common uropathogens, especially Escherichia coli. While there are established guidelines recommending specific first-line therapies, a noticeable gap remains between the evidence and what actually occurs in clinical practice, with fluoroquinolones like ciprofloxacin often being overprescribed for uncomplicated infections. The rising presence of multidrug-resistant organisms, such as extended-spectrum beta-lactamase-producing Enterobacterales, necessitates a careful reassessment of treatment strategies and a commitment to antimicrobial stewardship. With resistance rates exceeding 50% in certain regions for commonly used antibiotics, there's an urgent need for innovative treatment strategies, enhanced surveillance systems, and responsible antibiotic use to preserve the effectiveness of current therapies and address the escalating threat of antimicrobial resistance in managing UTIs.

Keywords:

Cite this article:
Fadilullahi Opeyemi Ibiyemi, Deborah Awoniran, Anthony Godswill Imolele, Ismail Kolawole Odetayo, Lawal Fatimah Ayomide. Evidence-Based Management of Urinary Tract Infections: Balancing Efficacy, Safety, and Antimicrobial Stewardship. IJRPAS, October 2025; 4(10): 26-49.DOI: https://doi.org/https://doi.org/10.71431/IJRPAS.2025.41003


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92.  McOsker CC, Fitzpatrick PM. Nitrofurantoin: mechanism of action and clinical effectiveness in the context of antimicrobial resistance. Diagn Microbiol Infect Dis. 1994;19(1):21-27.

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95.  Cui N, Bian X. Fluoroquinolone-associated tendinopathy: a systematic review. J Clin Pharm Ther. 2021;46(4):927-939.

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102. McOsker CC, Fitzpatrick PM. Nitrofurantoin: mechanism of action and clinical effectiveness in the context of antimicrobial resistance. Diagn Microbiol Infect Dis. 1994;19(1):21-27.

103. Andersson MI. Development of the quinolones. J Antimicrob Chemother. 2003;51(suppl 1):1-11.

104. Aldred KJ, Kerns RJ, Osheroff N. Mechanism of quinolone action and resistance. Biochemistry. 2014;53(10):2155-2164.

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106. Cunha BA. Antibiotic side effects. Med Clin North Am. 2001;85(1):149-185.

107. Cui N, Bian X. Fluoroquinolone-associated tendinopathy: a systematic review. J Clin Pharm Ther. 2021;46(4):927-939.

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113. Paranos A, Pešaković M, Mićić M. Nitrofurantoin: mechanism of action and resistance. J Chem. 2022;2022:1-12.

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116. Aldred KJ, Kerns RJ, Osheroff N. Mechanism of quinolone action and resistance. Biochemistry. 2014;53(10):2155-2164.

117. Cunha B. Nitrofurantoin: mechanisms of action and drug interactions. J Med. 1989;20(3-4):287-295.

118. Cunha BA. Antibiotic side effects. Med Clin North Am. 2001;85(1):149-185.

119. Cui N, Bian X. Fluoroquinolone-associated tendinopathy: a systematic review. J Clin Pharm Ther. 2021;46(4):927-939.

120. Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;(3):CD001209.

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122. Serwacki J, Klesiewicz K, Michalska A. The use of fluoroquinolones in combating bacterial pathogens: a historical and contemporary perspective. J Chemother. 2023;35(4):250-260.

123. Lungu I, Chirita I, Radulescu A. Fluoroquinolones: evolution, spectrum of activity, and clinical applications. Rev Chim (Bucharest). 2022;73(10):2400-2410.

124. Wang J, Yin Y, Wang C, et al. The mechanism of nitrofurantoin-induced organ toxicity: a review of current literature. Chem Biol Interact. 2008;175(1-3):23-29.

125. Paranos A, Pešaković M, Mićić M. Nitrofurantoin: mechanism of action and resistance. J Chem. 2022;2022:1-12.

126. McOsker CC, Fitzpatrick PM. Nitrofurantoin: mechanism of action and clinical effectiveness in the context of antimicrobial resistance. Diagn Microbiol Infect Dis. 1994;19(1):21-27.

127. Andersson MI. Development of the quinolones. J Antimicrob Chemother. 2003;51(suppl 1):1-11.

128. Aldred KJ, Kerns RJ, Osheroff N. Mechanism of quinolone action and resistance. Biochemistry. 2014;53(10):2155-2164.

129. Cunha B. Nitrofurantoin: mechanisms of action and drug interactions. J Med. 1989;20(3-4):287-295.

130. Cunha BA. Antibiotic side effects. Med Clin North Am. 2001;85(1):149-185.

131. Cui N, Bian X. Fluoroquinolone-associated tendinopathy: a systematic review. J Clin Pharm Ther. 2021;46(4):927-939.

132. Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;(3):CD001209.

133. Bradley JS, Garau J, Lode H, Rolston KV, Wilson SE, Quinn JP. Carbapenems in clinical practice: a guide to their use in serious infection. Int J Antimicrob Agents. 1999;11(2):93-100.

134. Serwacki J, Klesiewicz K, Michalska A. The use of fluoroquinolones in combating bacterial pathogens: a historical and contemporary perspective. J Chemother. 2023;35(4):250-260.

135. Lungu I, Chirita I, Radulescu A. Fluoroquinolones: evolution, spectrum of activity, and clinical applications. Rev Chim (Bucharest). 2022;73(10):2400-2410.

136. Wang J, Yin Y, Wang C, et al. The mechanism of nitrofurantoin-induced organ toxicity: a review of current literature. Chem Biol Interact. 2008;175(1-3):23-29.

137. Paranos A, Pešaković M, Mićić M. Nitrofurantoin: mechanism of action and resistance. J Chem. 2022;2022:1-12.

138. McOsker CC, Fitzpatrick PM. Nitrofurantoin: mechanism of action and clinical effectiveness in the context of antimicrobial resistance. Diagn Microbiol Infect Dis. 1994;19(1):21-27.

139. Andersson MI. Development of the quinolones. J Antimicrob Chemother. 2003;51(suppl 1):1-11.

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