Q. What are the ways to treat recurring UTI?

Answered by
Dr. Samer S J Altawil
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Jun 08, 2020 and last reviewed on: Jun 20, 2020

Hello doctor,

I have recurring UTI. Last time,a few months back, after taking medicines for the recurring UTI, results were normal. I took Cital syrup and antibiotics. After experiencing pain recently I again went for urine test, and it shows RBC, epithelial cells and bacteria. I have attached the reports. I was consulting a gynecologist prior to this, but she told me to consult a urologist. I have attached my last ultrasound and kidney function test along with today's urine test.



Welcome to

After reviewing your complains and your blood and urine test with ultrasound reports (attachment removed to protect patient identity), kidney functions are normal, your ultrasound is normal, your urine analysis showed pus cells and few red cells and white blood cells.

My question is do you have symptoms like difficulty in passing urine? Or pain while passing urine? If not then did you have urine culture result before your antibiotics treatment? If you have documented UTI before and you got treated then you have pus cells and white cells in urine, your test might have been performed soon after antibiotics. The possibilities are incomplete treatment or chronic inflammation of the urinary bladder as sending infections are also common in postmenopausal period.

You will need to follow up with urine culture test, if it is negative and you have no symptoms then no need to treat. If it is negative and you are still having symptoms (pain while passing urine), we need to do more tests. I hope to follow up you after urine culture results. As preventive measure, you need proper hydration, cranberry juice, yogurt and proper hygiene.

The Probable causes:

Cystitis, incomplete treatment.

Investigations to be done:

Urine culture.

Differential diagnosis:

Cystitis bacterial, TB.

Probable diagnosis:


Treatment plan:

Observation and hydration.

Preventive measures:

Hydration cranberry juice, yogurt.

Regarding follow up:

4 days after urine culture.

Hi doctor,

I have no difficulty or pain in passing urine. Yes, my earlier treatment was done after culture test. Actually, all this started when I visited gynecologist after lower back pain. She gave me suppository, and after taking it postmenopausal bleeding occurred. So I tested for uterine and cervical cancer, both the tests were negative. I was then treated for UTI after urine culture and blood culture showed bacteria. After 5 days of treatment, blood culture was sterile but urine still showed bacteria, so I was treated with Augmentin-375 for 40 days. After this, I recovered. Now after one month, I again experienced these symptoms like lower back pain, burning sensation and bloating. Also, I mistakenly consumed wheat which was a few days past expiry date. I am attaching my culture test as per your instruction and also the routine test I again went for today. Currently, my temperature is between 98-99 degrees F. I am feeling heat throughout my body especially feet. I also have slight headache. Please provide mild medicines as I am a bit sensitive towards medicines. I also want to tell that Ciplox does not suit me.



Welcome back to

Thank you very much for updating me the test results.

Your current urine culture is negative but you still have pus cells and bacteria in your urine. We call it sterile pyuria which can be due to stones, foreign body radiation or TB in urine.

You do not have history of radiotherapy and your ultrasound last time was normal so you will need urine test for TB (urine test) and x-ray of chest furthermore you will need uroflow post void bladder scan to make sure you can empty completely your bladder. At this time observe your temperature and no need to take antibiotics. If you have fever above 99, then you will need admission otherwise just to do urine for TB and bladder scan. Further work up will be if your urine is negative for TB and chest x-ray in addition to bladder scan. I recommend you to have flexible cystoscope and bladder biopsy.

I hope you will get well. Please update me your further investigation so we can proceed towards your treatment better.

Investigations to be done:

Chest x-ray, urine for AFB culture/PCR, uroflow and bladder scan.

Differential diagnosis:

TB cystitis.

Treatment plan:

Paracetamol 1 gm tds in case of fever and admission.

Hi doctor,

Please look at all the pages of the file I sent you, the culture report is positive. I am sending it again.



Welcome back to

Thank you again for consulting me.

The report you sent is urine analysis which I saw already have pus cells and white cells. But the culture if you read down below shows no bacterial growth so urine is sterile and negative. For better explanation please do a video call so I can explain you more clearly. The plan for follow up is as I mentioned above.

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