Urology

Have Urology Questions? Ask a Urologist Online.

Ask a Doctor,
Get an Answer ASAP!

Urology
This answer was rated:

If I am taking Nitrofurantoin as a prophylactic against

UTI’s (100 mg/day for about...
If I am taking Nitrofurantoin as a prophylactic against UTI’s (100 mg/day for about six weeks now), how do I know whether or not I have a UTI? The way I usually knew was very frequent urination (every ninety seconds; that cannot occur when using a catheter; sometimes after/while using catheters I feel like I need to urinate but cannot of course). So just wondering how I know if I would have a UTI.
Further, if I went into the doctor’s office/after lab office, how would they diagnose whether I had a UTI? I take it test strips are not effective when on Nitrofurantoin? Or is it more accurate that if an infection the bacteria will still show up because the Nitrofurantoin is not killing them? And if the strips do not work, would a culture show whether a UTI exists?
Thank you.
Show More
Show Less
Ask Your Own Urology Question
Answered in 15 minutes by:
5/6/2013
Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3,682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Verified
HI

The urine strips are ineffective when on antibiotic because the all the bacteria are killed by the antibiotic and hence the urine becomes sterile.So that is aim of any antibiotic - to make the urine sterile.Hence the culture will also come negative.

The main criteria to decide whether you have UTI or not is the symptom complex.If you are symptom free you are very less likely to have an UTI.So when on antibiotic if you develop symptoms then you have an UTI and it will detected on various tests.

It is symptoms which governs the whole thing.So many old patients have positive urine tests without symptoms .They are never treated for infection.As rightly said treat the patient not the investigations.

I hope this answers your question.

Regards

Dr.Tharun
Ask Your Own Urology Question
Customer reply replied 4 years ago

Don't follow most of your response.

If all the bacteria are killed, then how can you a UTI?

And if can still get a UTI, then how do you know as a patient that you have a UTI? What are the symptoms?

How would a doctor diagnose whether you had a UTI if taking antibiotics?

And if as you say many older patients have UTI without symptoms, isn't that dangerous? If so. what do you recommend to avoid this?

Thank You. I have follow-up questions that will be asked as a new question(s).

Hello Greg,

If all the bacteria are killed, UTI cannot occur.Only if the antibiotic is ineffective or bacteria virulent and resistant UTI can occur.UTI occurs due to reinfection by the same bacteria or another bacteria after stopping of antibiotic.

If you are on antibiotics and have an UTI, the symptoms will be same as any normal UTI.Frequency, Urgency, burning, lower abdominal pain , fever etc.

UTI can be diagnosed with a urine test and urine culture only.So if they are positive you have an UTI.

In older patients it is a norm to treat only symptomatic UTI.Older patients can have pus cells in the urine without infection.It is called pyuria of aged.So it is not necessary to treat every positive urine test in an elderly unless it is symptomatic.Sometimes bacteria can be normally residing in the urinary system without causing harm.They are called commensals.

I hope this clarifies your doubt.

Regards

Dr.Tharun
Ask Your Own Urology Question
Customer reply replied 4 years ago

Ok. Please clarify initial statement that culture will also come negative, and later apparenlty conflicting statement that UTI can be diagnosed with a urine test and urine culture only.

And if no bacteria means no UTI, then UTI must mean bacteria. So why wouldn't the strips work? But a culture would work (see first sentence above).

Thank you.

The culture will come negative if the urine is sterile - that is devoid of bacteria as they are killed by the antibiotic.That is why culture is always done before starting the antibiotic.Once antibiotic is started the culture is negative, so UTI is responding and being treated.

Strips works by detecting the pus cells which contain specific enzymes which cause chemical changes as indicated by change in color of the strip.So it mainly detects pus cells in the urine which is an indirect evidence of UTI.

Culture means actual growth of the bacteria in medium which is almost confirmatory that the bacteria were present in the urine.

Regards

Dr.Tharun
Ask Your Own Urology Question
Customer reply replied 4 years ago

I think you are missing my point.

I am taking Nitrofurantoin as a prophylactic against UTI’s (100 mg/day for about six weeks now), Can I still get a UTI? Only if the bacteria becomes resistant to the Nitrofurantoin? I have heard it is possible, but probably not after just six weeks. I have heard various opinions; my pharmacist says she knows of several men and women using Nitrofurantoin as a prophylactic for years without a problem; yet, one urologist said that taking Nitrofurantoin every day will result in resistance 100% of the time.

You state that the culture will come back negative if the urine is sterile - that is devoid of bacteria as they are killed by the bacteria. But if somehow the bacteria becomes resistant, you can still get a UTI. Would that not be detectable by a strip and/or culture since now bacteria are present?

HI

Yes, culture and strip test will detect the bacteria and pus cells if they are resistant against the prescribed antibiotic.

You can get a UTI while on prophylactic antibiotics and it is called break through infection.And culture will detect the infection in that case too.

Dr.Tharun
Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3,682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Verified
Dr. Tharun and 87 other Urology Specialists are ready to help you
Ask your own question now
Customer reply replied 4 years ago

So the only way you can obtain a UTI if taking Nitrofurantoin is if the bacteria becomes resistant, or can you get a UTI even if the bacteria does not become resistant? One reason I ask if that an expert told me that for the amount of urine I retain, that 50 g per day would not be sufficient; e.g., bacteria greater than Nitrofurantoin can handle.

How likely is it to receive a UTI while taking Nitrofurantoin? What have you seen as far as resistant strains of bacteria evolving? Have you seen doctors alternate between Nitrofurantoin for a period of time than switching to another antibiotic for another period of time and then back again to prevent this from occurring? Your opinion/recommendation? Thank you.

Hi

you can get an UTI if the bacteria are resistant to the given antibiotic.Urine dwell time is one of the factors for re-infection.If urine dwell time is more , then naturally bacteria will get more time to divide as well as attack the urinary system.

Nitrofurontoin is almost lost in past as most of the doctors find it not very useful in prophylaxis and also its side effect in causing lung problems.

Most of the time, low dose cephalosporins are good enough for prophylaxis and provide a better shield against these bacteria.

Regards

Dr.Tharun
Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3,682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Verified
Dr. Tharun and 87 other Urology Specialists are ready to help you
Ask your own question now
Customer reply replied 4 years ago

I went to Urgent Care this afternoon after AZO test strips at home showed positive for leukocytes twice. The sample at urgent care showed low in leukocytes and the doctor prescribed 250g of Cipro twice a day for five days. Does that sound reasonable?

I have concern in that my symptoms were not overwhelming, and I don't know long how I may have had the UTI (that is, if the culture comes back positive). No blood was found in the urine.

I asked the doctor if after the 5 days it was safe to go back on the nitrofurantoin as a prophylactic, and he said that in the 5-day interim that may help defeat the resistance, and said we would cross our fingers that that would be the case. What is your view on that?

I finally have my appointment to see a new urologist on Thursday, May 16th. Perhaps I should ask her about cephalosporins as a prophylactic for UTI's. What is the cephalosporin usually prescribed. Doesn't that have the same concern for resistance? Should a patient rotate prophylactic antibiotics monthly to avoid this. I generally retain 300-400 ml of urine: I take it that makes it more likely for me to develop UTI's when using a catheter even with antibiotics?

I never had a UTI unless using a catheter. I am wondering whether in a risk/benefit analysis it is better for me not to use a catheter and risk any damage to my bladder from retention? I have had no kidney problems to date but worry that UTI's from catheter use could result in that. The only side effect to date is a thickening of the bladder wall.

I have asked quite a few questions here. Feel free to answer some, and I will ask the remainder in a new question to better compensate you for your time. Thank you.

.

Thank you.

Hi Greg,
Cipro seems like a reasonable choice.We cannot deny that.
If there is resistance to one antibiotic , it will not be resolved in 5 days.Once you break into infection even on antibiotic, it is better to stay away from the antibiotic for some time like months.
Cifixime can used for prophylaxis.
Bacteria are intelligent organisms and give them a small window , they will develop resistance.This will be never ending phenomenon with antibiotics and bacteria.
Change the antibiotics when it does not work, that is general protocol being followed in medical community.
Infections in the bladder will not cause damage to the kidneys.Only if the infection reaches the kidney which is rare, there can be damage.
Chronic retention of urine will eventually lead to kidney damage, that is sure thing.A sure thing triumphs over a rare chance.
Regards
Dr.Tharun
Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3,682
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
Verified
Dr. Tharun and 87 other Urology Specialists are ready to help you
Ask your own question now
Ask Dr. Tharun Your Own Question
Dr. Tharun
Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3,682
3,682 Satisfied Customers
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.

Dr. Tharun is online now

A new question is answered every 9 seconds

How JustAnswer works:

  • Ask an ExpertExperts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional AnswerVia email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction GuaranteeRate the answer you receive.

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me.

Susan O.USA

I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much

Corrie MollPretoria, South Africa

I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well!

ClaudiaAlbuquerque, NM

Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion.

KevinBeaverton, OR

Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
I feel better already! Thank you.

ElanorTracy, CA

Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem.

JulieLockesburg, AR

You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions.

John and StefanieTucson, AZ

< Previous | Next >

Meet the Experts:

Dr. Y.

Dr. Y.

Urologist

20,150 satisfied customers

I am fellowship trained specializing in general urology and reconstructive urology.

Dr. Tharun

Dr. Tharun

Urology Resident

3,682 satisfied customers

MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.

urologyguru

urologyguru

Urologist MD

1,088 satisfied customers

I am fellowship-trained MD Urologist in active practice. I treat all types of cases from genital, cancer, urinary, stone and incontinence.

Dr Josh

Dr Josh

Physician

255 satisfied customers

General Physician, PGCSD

Ross

Ross

Urologist

62 satisfied customers

urologist

Dr. B

Dr. B

Urologist

62 satisfied customers

Trained in Adult and Pediatric Urology, Fellowship trained in Urologic Oncology.

Family Physician

Family Physician

Doctor

2,592 satisfied customers

Emergency Medicine and Family Practice for over 26 years

< Previous | Next >

Related Urology Questions
Went and seen a urologist for some kidney and bladder
I'm I went and seen a urologist for some kidney and bladder problems, such as about 10kidney stone surgeries, removal of left kidney, and a series of 5 Botox injections to raise my bladder! The last p… read more
Ross
Ross
Urologist
62 satisfied customers
A recent scan of my kidneys and bladder show that my bladder
A recent scan of my kidneys and bladder show that my bladder is full of cysts. Can they be removed? Will it help the urine flow. How re they removed. … read more
Ross
Ross
Urologist
62 satisfied customers
The patient had a gastric sleeve procedure. The kidneys were
The patient had a gastric sleeve procedure. The kidneys were perfectly fine up until December 13, 2017. 3 days prior to the surgery, the surgeon gave her diuretics to lower her blood pressure. After t… read more
Dr. Muneeb Ali
Dr. Muneeb Ali
Senior Registrar Critical Care Medicine
Doctoral Degree
7,285 satisfied customers
My bladder is not emptying completely Is there a medication
my bladder is not emptying completely Is there a medication that can assist with this? … read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,677 satisfied customers
I have been experiencing overactive bladder since September.
I have been experiencing overactive bladder since September. I have done urine cultures no bacteria isolated and told that I needed to improve on pelvic exercise and to take pro-banthine 15Mg for two … read more
Dr Uzair
Dr Uzair
FCPS (R) General Surgery
M.B.,B.S. FCPS
3,696 satisfied customers
I have kidney stones, two larger ones in my right kidney.
I have kidney stones, two larger ones in my right kidney. Just have pain once in awhile when they move. A week ago had noticeable blood in my urine, but no pain. Urine is clear now, but in the urine t… read more
Dr. K.
Dr. K.
Staff physician
538 satisfied customers
Can a ureter get infected without the bladder being
can a ureter get infected without the bladder being infected … read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,921 satisfied customers
Male, age 43, feeling pressure on my bladder and urination
Male, age 43, feeling pressure on my bladder and urination is somewhat painful. What are my next steps toward determining if this could be a prostate issue, or a kidney stone, or something else?… read more
Dr Anil Kumar
Dr Anil Kumar
M.B.B.S
2,722 satisfied customers
What is the purpouse of stents in bladder. She had an
She had an infection urinary and they installed stents … read more
Dr. Muneeb Ali
Dr. Muneeb Ali
Senior Registrar Critical Care Medicine
Doctoral Degree
7,285 satisfied customers
I have an overactive bladder! and recently have discomfort
I have an overactive bladder! and recently have discomfort in the kidney area! … read more
Dr.Saleem
Dr.Saleem
Consultant Cardiologist
Doctoral Degree
764 satisfied customers
I have a bladder or kidney infection, I tested my urine this
I have a bladder or kidney infection, I tested my urine this am . I have been very sick and dreadful pain … read more
Dr. Phil, MD
Dr. Phil, MD
Internal Medicine Physician
Doctoral Degree
2,677 satisfied customers
I have routine bad kidney or perhaps bladder infections
I have routine bad kidney or perhaps bladder infections extremely often. Often I get a sensation that goes all the way up my frontal up through my breasts as I am urinating. Very strange sensation.… read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,921 satisfied customers
Just had US of kidneys bc of blood in urine. Right one shows
Just had US of kidneys bc of blood in urine. Right one shows a color cluster of red and blue dots. And also shows a circle measuring 1 cm on a different image. Can this be a kidney stone? Or something… read more
DR. EHTISHAM
DR. EHTISHAM
Consultant Physician& Rheumatologist
Doctoral Degree
1,393 satisfied customers
I recently had an ultrasound on my bladder and kidneys Would
I recently had an ultrasound on my bladder and kidneys Would like to discuss with a doctor. … read more
Dr. D. Love
Dr. D. Love
Doctoral Degree
10,394 satisfied customers
I have issues with urinating and bladder pain for 10 months
hi there, I have issues with urinating and bladder pain for 10 months now. I've had a cystoscopy and pelvic ultrasound with no significant findings. I'm wondering if it's possible that I have a prolap… read more
Dr. Arun Phophalia
Dr. Arun Phophalia
Consultant Surgeon and Sports Medicine
Post-Doctoral Degree
32,921 satisfied customers
My urine bladder is quite streched due to time retention of
My urine bladder is quite streched due to long time retention of urine. It was happening before I had UROLIFT prostate operation done last month. After that I was on catheter with a bag on my leg for … read more
Troy Adolfson
Troy Adolfson
Medical Degree (MD)
50 satisfied customers
Tracers of blood in my urine and bladder does not empty
tracers of blood in my urine and bladder does not empty completely have slight burning sensation when urinating what's wrong and what are alternates to catherization ?… read more
Dr Uzair
Dr Uzair
FCPS (R) General Surgery
M.B.,B.S. FCPS
3,696 satisfied customers
Are there any symptoms of a "dead" bladder. If your urine
Are there any symptoms of a "dead" bladder. If your urine stream is normal at times is that evidence that your bladder is not "dead?"… read more
Dr. David
Dr. David
Radiation Oncology Attending Director
Post-Doctoral Degree
13,092 satisfied customers
Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

Show MoreShow Less

Ask Your Question

x