Urinary tract infections (UTIs)
A UTI is an infection somewhere along the route urine takes. Most often it is the bladder, and then we are talking about cystitis; less often the infection…
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Medicines commonly prescribed for Urinary tract infections (UTIs)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 250 mgActive substance: amoxicillinManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 583 mgActive substance: ciprofloxacinManufacturer: Industria Quimica Y Farmaceutica Vir S.A.Prescription requiredDosage form: CAPSULE, 500 mgActive substance: amoxicillinManufacturer: Laboratorios Cinfa S.A.Prescription required
A UTI is an infection somewhere along the route urine takes. Most often it is the bladder, and then we are talking about cystitis; less often the infection travels up to a kidney, and that is more serious. Urethritis sits slightly apart: it is inflammation of the outflow tube itself, in men usually caused by a sexually transmitted infection, and it is treated differently, so burning together with discharge is not cystitis and must not be treated "like cystitis". Most UTIs settle well and some without antibiotics at all. But there are two groups in whom the picture looks nothing like the textbook, and those are exactly the people with whom time gets lost: older adults and young children.
What it usually looks like
In an adult the picture is fairly recognisable:
- burning or stinging when passing urine;
- going to the toilet often, a small amount each time and with the feeling that something is left;
- sudden urges that are hard to hold, including at night;
- heaviness, pressure or pain above the pubic bone;
- cloudy urine, sometimes pink or with visible blood;
- feeling generally rough; in older people the temperature may not rise at all and can even drop below normal.
And now the point that overturns half of all home diagnoses: cloudy, strong-smelling urine is not a diagnosis on its own. Usually it means not enough water has been drunk, and sometimes it is asparagus or a vitamin supplement. If there is nothing beyond the colour and the smell, start by drinking more and watch for a day or two. The reverse is also true: bacteria found in the urine of someone who has no symptoms and is not pregnant are usually left alone. There is no need to test urine "just in case" when nothing is wrong, because the bacteria that turn up drag people into an antibiotic course they did not need.
In an older person it looks completely different
Almost nobody writes about this, and anyone with elderly parents should know it. In an older person the only sign of a urinary tract infection may be sudden confusion and weakness, with no pain, no burning and no fever. From the outside it looks like this: yesterday they were themselves, and today they are muddled, lose track of what time of day it is, do not recognise familiar surroundings, have become agitated or unusually drowsy, have stopped getting up, have started falling, and incontinence that was manageable has abruptly got much worse.
Relatives in that situation think of everything else — tiredness, dementia, "going downhill" — and reach a doctor a week later. Yet this is one of the commonest causes of sudden confusion in old age, it is sorted out with a simple urine test and it treats well if it is not left. The rule is straightforward: a sudden change in an older person's behaviour or mental clarity means being seen by a doctor the same day, not watched. There are many causes of such a change and a urinary infection is only one of them, but it is checked first because it is quick and easy.
In children
Below a certain age children cannot tell you it hurts to pass urine, so a UTI hides behind general signs:
- a temperature with no obvious source: no runny nose, no cough, no rash, no diarrhoea, and yet a fever;
- refusing food and drink; in babies, feeble feeding and poor weight gain;
- vomiting and tummy pain;
- irritability or unusual listlessness;
- in a child who has long been dry, daytime or night-time wetting that has come back;
- strongly smelling urine.
All of this is a reason to test the urine rather than wait. In small children the sample is collected in a particular way and the doctor will explain how; collected wrongly it gives a false result. And one more thing: a confirmed urinary infection in a young child is sometimes the first clue to a difference in how the urinary tract is built, which is why an ultrasound scan is often arranged afterwards. That is not over-caution, it is how something correctable is found in time.
What to do in the first twenty-four hours
For uncomplicated cystitis in an otherwise healthy woman who is not pregnant, there is not always any rush for an antibiotic: a proportion of these episodes clear on their own within a few days. What helps in the meantime:
- drink plenty: the urine becomes less concentrated, irritates the bladder less, and bacteria are flushed out more readily;
- a painkiller: paracetamol or, if there is nothing against it, an anti-inflammatory; both ease the pain and bring down a temperature;
- warmth on the lower abdomen, loose underwear, not holding on when you need to go, and trying to empty the bladder fully.
By contrast, waiting is not an option and antibiotics need discussing straight away if the person is a man, pregnant, a child, catheterised, diabetic, immunosuppressed or has kidney stones; if the symptoms are severe; or if nothing has improved in two days or things have got worse. Whatever course is prescribed is finished in full, even if the burning stopped on day two. And do not start on leftover antibiotics from the cupboard: a good share of the resistance problem grows from exactly there.
When it is no longer just the bladder
See a doctor the same day if you develop:
- pain in the loin or side together with a high temperature and shivering: that is a kidney infection and it cannot be treated like ordinary cystitis;
- vomiting that stops you keeping fluids or medicines down;
- blood in the urine;
- being unable to pass urine with a full and painful bladder;
- symptoms in a man: in men a UTI always calls for examination and a search for the cause;
- a temperature in a baby in the first months of life, or in a child who is clearly unwell.
Pregnancy is a separate matter. In pregnancy a UTI is always treated, including symptomless bacteria in the urine, which outside pregnancy would be left alone: untreated, it markedly raises the risk of a kidney infection and of premature birth. That is why urine is checked routinely at antenatal appointments, and the same day if there are any symptoms; the medicine is chosen by a doctor, because not all of them are suitable.
Call an ambulance (112 is the single emergency number across Europe) if the signs of infection are joined by confusion, drowsiness the person is hard to rouse from, slurred speech, very fast breathing, a temperature below normal, or cold and mottled hands and feet. That is what sepsis looks like, and here hours count.
Cranberry, herbal remedies and supplements
Let us separate two things at the outset: discussing them makes sense for preventing repeat episodes, not for treatment. Cranberry, herbal teas and D-mannose do not cure an infection that has already started and do not replace an antibiotic where one is needed. Drinking cranberry juice instead of seeing a doctor about loin pain with a fever is precisely the mistake that ends in a hospital admission.
What is known about prevention: in women with recurrent cystitis, cranberry products may slightly reduce the number of episodes, but the evidence is weak, and in men, children and people with catheters no effect has been shown. The practical caveats matter too: cranberry juices and supplements contain a lot of sugar, and cranberry strengthens the effect of warfarin, so anyone on anticoagulants should avoid it. For D-mannose there is even less data. If you want to try it, try it, but as an addition and after speaking to a doctor, particularly in pregnancy.
When UTIs keep coming back
Two episodes in six months or three in a year are no longer bad luck but a reason to look for the cause instead of writing a fourth course of antibiotics. Endless courses bring temporary relief and breed resistant bacteria while the cause stays exactly where it was. And there is usually something to find: incomplete bladder emptying, an enlarged prostate in men, stones, constipation — especially in children — poorly controlled diabetes, a long-term catheter, spermicides and a diaphragm as contraception, and in women after the menopause a thinning of the lining from lack of oestrogen.
What genuinely breaks the cycle:
- dealing with whatever cause is found, from treating constipation to changing contraception;
- local oestrogen as a cream or pessary for women past the menopause: one of the most effective measures and one of the most overlooked;
- drinking enough through the day, the one everyday measure with decent evidence behind it;
- not holding on when you need to go, emptying the bladder after sex, wiping front to back, and avoiding perfumed intimate hygiene products;
- where a doctor decides it is appropriate, preventive regimens: a small dose at night, a dose after sex, or a prescription issued in advance so treatment can be started at the first symptom.
If symptoms persist while urine tests keep coming back clear, that does not mean it is imaginary: long-term forms exist, and so do other conditions with similar complaints. That situation calls for a urologist, not another course taken blind.
Online consultation
Online is a convenient place to settle the commonest question: is this a UTI, and are antibiotics needed right now. A doctor can sort through the symptoms, say whether a day or two of waiting is reasonable or whether it is not, explain how to collect a urine sample properly and what the result means, help tell cystitis from urethritis, and advise on what to do if symptoms do not settle after a course. If UTIs keep returning, you can work out together what is keeping them going and build a prevention plan instead of stringing antibiotics one after another. It is especially worth getting in touch if an older relative has suddenly become confused or unusually weak — this is the sort of thing to ask about today. Loin pain with a high temperature and shivering, vomiting, blood in the urine, being unable to pass urine and any symptoms in pregnancy all need a face-to-face appointment the same day; confusion with drowsiness and fast breathing needs an ambulance.
This material is for information only and does not replace medical advice.
Consult with a doctor about Urinary tract infections (UTIs)
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Urinary tract infections (UTIs)
Discuss your symptoms and possible next steps for Urinary tract infections (UTIs) with a doctor online.
