UTI Medication Solutions Using Pharmacogenetic Testing

UTI Overview

Urinary tract infections (UTIs) are a common occurrence, particularly amongst females. They affect various sections of the urinary tract, and certain features can alter the treatment approach (for example, involvement of the kidneys, certain symptoms including fever etc.)

UTIs usually arise when bacteria colonize entry points into the urinary tract (e.g., areas of the genitals). This can be due to a number of reasons, including sexual intercourse, urinary incontinence, obstructions in the urinary tract, and presence of a urinary catheter. Bacteria can then travel to other areas of the urinary tract, causing infection.

How Antibiotics for UTIs are selected

Antibiotics are selected based on a health care provider's evaluation and usually includes (but may not be limited to) consideration of an individual's symptoms, age, sex and pregnancy status. This information usually narrows down the likely bacteria responsible, which in turn helps the prescriber to determine suitable antibiotic(s). Antibiotics differ in their ability to kill or contain specific bacteria. Other considerations include those seen when prescribing other types of medications, and include general safety and side effects risks, drug interactions, allergies, and considerations specific to the individual being treated (e.g., difficulty swallowing larger tablets).

In more severe cases, additional investigations, like a urine sample analysis, may also be done. Urine analyses can often indicate the specific antibiotics that the bacteria are susceptible or resistant to, providing additional insight to the prescriber.

UTI Antibiotic Side Effects & Role of Genetics

Though many antibiotics are commonly associated with nausea and diarrhea, these don't appear to have known, direct links to someone's genetics. However, certain UTI medication side effects do have genetic links, and these tend to be more severe in nature. More precisely, these links are referred to as pharmacogenetic associations.

Some individuals carry pharmacogenetic variations that increase the risk of experiencing a specific type of anemia when multiple known stressors are present in the body. These stressors include infections, and certain medications, including some antibiotics used for urinary tract infections. These antibiotics include nitrofurantoin and ciprofloxacin.

The antibiotic combination sulfamethoxazole-trimethoprim also carries the risk noted above, but also has other risks heightened by the presence of specific genetic factors. In particular, the risk of severe reactions involving potential detachment of the skin from the body are possible. In fact, some data suggests that the risk of this type of side effect contributing to emergency department visits or hospitalization is notably high in adults 66 years of age and older1. 

More severe UTIs treated with aminoglycoside antibiotics like gentamicin (usually given IV or IM in health care settings) can cause irreversible hearing loss in individuals with certain genetic variations.

Using Pharmacogenetic Results to Personalize UTI Care

UTI treatment medication decisions must consider the likely bacteria's susceptibility specific antibiotics (in addition to other, non-genetic factors). However, UTI pharmacogenetics testing can help health care providers better weigh the benefits and risks of the options available. This could mean that a different antibiotic is chosen (i.e., one without known pharmacogenetic associations), it could mean that certain confirmatory tests are ordered (in the case of the specific anemia risks discussed earlier), or more active and vigilant monitoring is done to limit the harm of an emerging side effect.

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