When the symptoms of interstitial cystitis and prostatitis virtually mimic that of a bladder infection, it’s only natural for patients and doctors to contemplate treating the urinary symptoms with an antibiotic. Go ahead! Admit it! You’ve probably raided your medicine cabinet in the middle of the night to take an antibiotic that you’ve saved. You might have even ordered antibiotics off of the internet. A desperate, burning bladder or prostate calls for desperate measures, right? Wrong! You should NOT self medicate with antibiotics. Here’s Why!

#1 – Infection rarely causes IC or prostatitis flares. Interstitial cystitis patients rarely test positive for infection and only 7% of the men who visit their doctors for prostatitis have active infection. The remaining 93% have other things going on in their pelvis, such as bladder wall injury, pelvic floor dysfunction, pudendal neuralgia, central sensitization, biomechanical stresses, etc. Experts state that antibiotics should only be prescribed AFTER a culture or Next Generation DNA testing are performed to verify not only the type of bacteria involved but also the most effective antibiotic to treat it with.

#2 – Don’t be fooled! Many antibiotics have an anti-inflammatory effect that can provide temporary relief but it won’t treat the underlying physiological problems from irritated Hunner’s lesions, bladder wall irritation, pelvic floor dysfunction or chronic non bacterial (Type 3) prostatitis. Long term antibiotic use can also lead to some dangerous complications and should only be used under close medical supervision if an acute or chronic infection is present.

#3 – The Risk of C-Diff. Antibiotics disrupt the normal bacterial flora in the gut which can then lead to an overgrowth of another bacteria, Clostridium difficile. C. Diff can cause a terrible  inflammation of the colon (aka colitis) and is usually manifested in the form of bloody diarrhea. C. diff is responsible for more than 450,000 infections each year and nearly 15,000 deaths. In recent years, it’s also become much more drug resistant and is now labelled a “superbug.” C. diff is highly contagious and can recur leading to life threatening complications. Learn about C-Diff here!  Watch an ABC News Video About It here! 

#4 – Have you been floxed? Some antibiotics are now associated with the risk of serious adverse events. Cipro and Levaquin, both fluoroquinolone medications, are no longer recommended for simple urinary tract infections with the FDA stating the risk of using these medications far out weigh the potential benefits, including the risk of aortic aneurysm. If you have Cipro, Levaquin or any other medications of this type sitting in your drawers waiting for a flare, please discard them properly. They are no longer recommended for the treatment of simple urinary tract infections nor IC flares. Learn More!

#5 – Drug Resistant Candida Infections. Antibiotics kill the bacteria that normally keep fungus (i.e. candida/yeast) in check thus creating the perfect environment for fungal overgrowth and infection.  The MAPP Research Network discovered that many IC patients struggling with flares actually have candida in their urine strongly suggesting that fungal infection could be present in many of us. The question is why? If there is one population of patients who have been overexposed to antibiotic therapy it’s the IC patient. Learn more!

#6 – The Critical Health Problem of Antibiotic Resistance. Antibiotic resistancy is now so common that experts report that 5 to 10% resistance rates in common bladder infections at urology clinics.  An estimated two million people become infected with antibiotic resistant pathogens and at least 23,000 die each year. One strain of E-coli (H30) has been linked to 1.5 million UTI’s and tens of thousands of deaths. It’s also gained the ability to spread from the urinary tract to the blood, which could lead to sepsis.  Taking antibiotics indiscriminately won’t kill all of the bacteria in the body. Those that survive are “resistant” and will reproduce yet more drug resistant bacteria. It’s a slippery slope.

Drug resistant infections cause more serious illnesses, deaths from previously treatable illnesses, prolonged recovery, more doctor visits, more invasive and expensive treatments. 

Antibiotic Stewardship

In March 2015, President Obama released the National Action Plan for Combating Antibiotic-Resistant Bacteria. He said:

“It addresses the problem from multiple angles at once: from stopping the spread of drug resistance right now through the more judicious use of antibiotics, to developing new antibiotics that will save and improve lives in the future, to working with partners worldwide to make sure that while we’re fighting drug resistance here in the United States, it isn’t gaining ground somewhere else in the world. And we’re working to significantly reduce the use of antibiotics in livestock and poultry, too. It’s a good plan. Now we need to carry it out. We can better protect our children and grandchildren from the reemergence of diseases and infections that the world conquered decades ago, but only if we work together, for as long as it takes.”

For the doctors and patients, one key element is to stop using antibiotics inappropriately. A recent survey on WebMD/Medscape found that 95% of health care professionals sometimes prescribe antibiotics when they aren’t sure they’re needed. The national plan provides better information on how doctors can confirm a diagnosis of infection before prescribing but it doesn’t have a specific plan for the patients. It’s really up to us to stop asking for antibiotics “just in case” our flare might be infection. We have to do the work to verify the infection before exposing ourselves and our families to the potential risks that antibiotics present.

How To Differentiate Between an IC Flare Vs. A Bladder Infection

When I first experienced bladder pain as an adult, I called my urologist dozens of times crying in pain because of a “possible bladder infection” and requested antibiotics. He, in a desire to be helpful, usually filled those prescriptions EVEN when my urine cultures were negative. In 27 years, I have only had TWO confirmed bladder infections. I now shudder when I think of all the antibiotics I consumed uselessly.

With the knowledge that IC flares might feel like infection, I now have a  very specific routine. As soon as I feel a flare or infection beginning, I test my urine with a UTI test strip. If it’s a double positive for leukocytes and nitrates, I call my doctor and request a urinalysis.  I’ll even take a picture of the test strip with my phone and email it in. If urine tests positive for both nitrates and leukocytes, that suggests active infection. Don’t just ask for antibiotics, make sure that you ask for a urine culture and antibiotic sensitivity test to determine which antibiotic will kill your specific infection.

(Don’t forget to track the identity of the bacteria and the antibiotic used in your personal medical records file so that you can see if there are any trends. Post menopausal women, for example, are much more prone to get recurring infections due to estrogen atrophy of the bladder wall as well as changes in the pH of the vagina.)

If the test strip only tests positive for leukocytes, I’ll generally wait 24 hours and then try again. The human body mobilizes leukocytes (white blood cells) when it senses a foreign invader in tissue which could be from bacteria but, in the case of IC, can also be the result of urine leaking into the bladder wall through Hunner’s lesions or glomerulations.

If you doubt the results of a culture, you can always request Next Generation DNA Urine Testing which will identify good bacteria, bad bacteria and fungal infections in your urine. In many states, you can request this without a referral. Learn more about this at: https://www.bladderhealth.org

Of course, if you have severe or increasing pain, blood in your urine, fever, dizziness or any other unusual or frightening symptoms,  you should call their doctor immediately even if your UTI test strips are negative. Consulting with a medical professional can verify the presence of infection or any other possible conditions, as well as just ease your mind and worries.


In light of the serious risks now posed by the overuse of antibiotics, we must resist the temptation to ask for them “just in case we have an infection” nor should we self medicate with old antibiotics. We must do the work to verify that we have infection first!

Updated: February 18, 2020
Created: January 31, 2017