Written by Miss Bria Mayer | Reviewed by Uche Ruth
Updated on June 11, 2024
When bacteria find their way into your bladder, pain and irritation may often follow. This is because bacteria can lead to a urinary tract infection (UTI) and stir up many bothersome symptoms. Frequent trips to the bathroom, a burning sensation while urinating, and pain are just a few. And in some cases, if these symptoms are left untreated, they could evolve into a more serious kidney infection — or even sepsis.
Thankfully, several antibiotics are well-equipped to treat UTIs before they become serious. Bactrim (sulfamethoxazole / trimethoprim) and Macrobid (nitrofurantoin monohydrate / macrocrystals) are two of the most commonly used antibiotics that treat UTIs — but some unique traits set them apart from one another.
Bactrim and Macrobid are both first-choice treatment options for “uncomplicated” UTIs. These are UTIs that affect women who aren’t pregnant, haven’t experienced menopause, and don’t have other urinary problems (like a kidney stone).
Bactrim and Macrobid are preferred because they work well and can help avoid complications that other antibiotics could cause. In a general sense, one antibiotic isn’t better than the other.
The best choice between the two may hinge on bacteria resistance patterns in your area, side effects you want to avoid, and any allergies you have. Cost can also play a role.
While Bactrim and Macrobid both treat UTIs, they work differently.
Bactrim is a combination of two antibiotic medications, sulfamethoxazole and trimethoprim. They work together to kill bacteria by stopping them from using folic acid, which they need in order to grow and spread. This helps prevent infections from spreading and getting worse.
Macrobid stops bacteria from growing. It does this by foiling bacteria’s ability to make DNA and other important structural materials. This gives your immune system a better chance to kill the bacteria. Macrobid also gathers (concentrates) in your urine, which helps it treat UTIs.
Macrobid is only approved and recommended to treat certain uncomplicated UTIs. This isn’t the case for Bactrim. Because Bactrim can fight different bacteria that cause infections, it can also treat infections, such as:
Since Bactrim and Macrobid work differently, they come with distinct doses and treatment durations. For uncomplicated UTIs:
These recommendations aren’t set in stone. You may receive a different dose depending on the bacteria at fault, your medical history, and if you recently had another UTI. Your age, pregnancy status, and the location where you live can also play roles.
You can find Bactrim and Macrobid’s active ingredients in multiple formulations.
Sulfamethoxazole and trimethoprim, the active ingredients in Bactrim, are available in three oral formulations:
While Bactrim is the more commonly used form of sulfamethoxazole and trimethoprim, you may see some providers prescribe Septra. This is another brand name version of sulfamethoxazole and trimethoprim that works the same way.
Nitrofurantoin, the active ingredient in Macrobid, also comes in three different oral formulations. The biggest difference between them is how the medication is prepared:
Bactrim and Macrobid can both cause side effects. But Bactrim is linked to side effects more often. It should also be avoided in people with sulfa allergies. Common Bactrim side effects include:
By comparison, Macrobid generally causes fewer side effects. Nausea, headaches, and diarrhea are the most common. It can also make your urine darker in color. However, more serious side effects are also possible. Although rare, Macrobid has been linked to lung damage, liver problems, and nerve pain in certain situations.
Bactrim and Macrobid can interact with other medications and foods. Some interactions worsen side effects, while others can impair treatment effectiveness.
Bactrim interacts with several medications and foods, such as:
Macrobid has fewer interactions than Bactrim overall. But it’s important to be mindful of certain ones. Watch out for antacids that contain magnesium, like Mylanta or Milk of Magnesia. They can bind to Macrobid in your gut and make it less effective. Probenecid can also hinder Macrobid’s ability to exit your body, which increases the risk of side effects. It also has its own interaction with methotrexate.
One of the largest drawbacks to Bactrim and Macrobid is that they generally shouldn’t be taken during pregnancy.
Bactrim can stop your body from using folic acid; this can potentially lead to birth defects. Macrobid can also be risky, but mostly during the beginning and end of pregnancy. When needed, Macrobid prescriptions are usually limited to the second trimester and parts of the third trimester.
Other antibiotics are safer to use during pregnancy. If you’re pregnant and have a UTI, your provider will likely recommend cephalexin (Keflex) or amoxicillin.
Bactrim and Macrobid are available as brand-name medications. But you can also find them as lower-cost generics.
These drugs are vital for controlling and improving the health of individuals with this condition. They include both preventive and symptomatic treatments.
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