UTI Drug Improves Symptoms Within a Day

More than half of women treated with gepotidacin for uncomplicated urinary tract infections (UTIs) experienced symptom improvement within 24 hours of starting the antibiotic, according to a study published this week in JAMA Network Open.Nearly 80% of patients' symptoms improved by 48 hours, although complete symptom resolution took a little over a week. For patients with recurrent UTIs, an increasing incidence of drug-resistant bacteria can leave clinicians with fewer oral treatment options. In those cases, gepotidacin may provide another choice before intravenous antibiotics become necessary, said Nazema Siddiqui, MD, associate professor of obstetrics and gynecology in the Division of Urogynecology & Reconstructive Pelvic Surgery at Duke University in North Carolina. But she cautioned that the results should not be used as evidence that gepotidacin works faster than other antibiotics."Everyone wants to feel better faster," but because the study did not include a comparison group, "you can't take this out of context and basically say that this means that this is going to work faster than other [antibiotics]," Siddiqui said. Gepotidacin is a first-in-class oral antibiotic approved by the FDA in 2025 for females aged 12 years and older to treat uncomplicated UTIs when caused by certain bacteria that are susceptible to the drug. Earlier phase 3 trials found gepotidacin worked at least as well as nitrofurantoin, a commonly used UTI antibiotic.The new phase 3b study was designed to examine how quickly patients began to feel better. Researchers enrolled 97 girls and women with at least two symptoms of uncomplicated UTI, including dysuria, increased urination frequency and urgency to urinate, and lower abdominal or pelvic pain. Ninety were included in the primary 24-hour analysis. Participants received 1500 mg of gepotidacin twice daily for 5 days and were assessed at 24, 48, 72, and 96 hours, then again on day 10. There was no comparison group.Clinical symptom improvement was defined as at least a 1-point decrease from baseline on a 12-point scale measuring pain/burning during urination and other symptoms, without the need for another systemic antibiotic.At 24 hours, 54.4% of clinically evaluable patients had improved. At 48 hours, 79.8% had improved. By day 10, 95.6% had improved and 90% had complete symptom resolution.The 24-hour data fill a gap left by the earlier trials, which assessed symptom improvement between days 2 and 4, and may provide clinicians clearer expectations on when a patient might feel better, a spokesperson for GSK told Medscape Medical News.The larger question is where a new antibiotic should fit into treatment as resistance increases, Siddiqui said. For patients with recurrent UTIs, drug-resistant bacteria can leave clinicians with fewer oral treatment options. In those cases, gepotidacin may provide another choice before intravenous antibiotics become necessary, Siddiqui said. But she cautioned against treating it as a "magic bullet.""If we start overutilizing this [gepotidacin], then we're going to start to get drug-resistant bacteria to this also," she said. That concern reflects the principle of antimicrobial stewardship — using the right antibiotic for the right patient at the right time while avoiding unnecessary antibiotic use, Siddiqui said.Among the study's other findings, 27 of the 97 participants experienced at least one adverse event. Gastrointestinal events occurred in 24% of cases, including diarrhea in 16%. Three patients discontinued treatment because of mild or moderate adverse events. Siddiqui said gastrointestinal symptoms are common with antibiotics generally and should be weighed against a patient's need for treatment. GSK funded the study and manufactures gepotidacin.Various study authors reported being employees and stockholders in GSK.Kelley Butler is a freelance writer based in the Washington, DC-metro area, covering a broad range of healthcare topics and trends.