UTI Treatment in Southlake, TX

Urinary tract infections are common, uncomfortable and usually straightforward to treat. The parts that matter are choosing the right antibiotic, recognizing when the infection has moved beyond the bladder, and working out why it keeps happening if it does.

Diagnosis

Burning with urination, urgency, frequency and lower abdominal pressure, without vaginal discharge or irritation, makes a UTI likely in a woman.

We check a urinalysis in the office. A culture goes out when the situation calls for one: treatment failure, recurrence, pregnancy, any male patient, a catheter, diabetes, kidney disease, or signs the kidney is involved.

For a simple first infection in an otherwise healthy woman, a culture is often unnecessary and we treat empirically.

When it is not a simple bladder infection

Fever, chills, flank or back pain, nausea and vomiting suggest pyelonephritis, a kidney infection. That is a different illness with a longer course of a different antibiotic and, sometimes, hospital care.

In men, UTIs are never routine. The prostate is usually involved, treatment runs longer, and a first infection deserves a look at what allowed it.

In older adults, confusion alone is often blamed on a UTI when the urine is simply colonized. Treating asymptomatic bacteriuria does not help and does cause harm, and we are careful about that distinction.

Treatment

Nitrofurantoin for five days and fosfomycin as a single dose are both good first choices for uncomplicated cystitis and both spare the broader-spectrum drugs.

Trimethoprim-sulfamethoxazole works well where local resistance permits. We avoid fluoroquinolones for simple bladder infections because of tendon, nerve and aortic risks that are not worth it for a straightforward UTI.

Nitrofurantoin does not work well with reduced kidney function, so we check your eGFR before prescribing it. See chronic kidney disease.

Phenazopyridine helps the burning while the antibiotic works. It turns urine bright orange, which is harmless and startling if nobody warns you.

Recurrent infections

Three or more in a year, or two in six months, deserves a proper look rather than a fourth prescription.

• After menopause, low estrogen thins the vaginal and urethral tissue and changes the bacterial environment. Vaginal estrogen has strong evidence for preventing recurrence and is safe for far more women than most believe. It is the single most effective intervention in this group and it is badly underused.
• Incomplete emptying, from pelvic floor problems or prostate enlargement.
• Kidney stones, which can harbor bacteria.
• Diabetes, where glucose in the urine feeds bacteria. See type 2 diabetes.
• Behavioral factors, including timing around intercourse, which are worth discussing without embarrassment.

Depending on the pattern we consider post-coital single-dose prophylaxis, methenamine, or imaging and a urology referral.

What we do not do

We do not treat a positive urine culture in someone with no symptoms, outside of pregnancy and certain urologic procedures. It does not prevent future infections, it does not help confusion in older adults, and it selects for resistant organisms.

When to call urgently

Fever above 101, back or flank pain, nausea or vomiting, blood in the urine that persists after treatment, or no improvement after 48 hours on an antibiotic.

Same-day appointments are covered on our sick visits page. See our primary care Southlake practice overview.