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Dr. Andrew Rynne

Family Physician

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Are burning micturition and cramping despite clear urine suggestive of UTI and how should it be treated?

Answered by
Dr. P. T. Patil


Practicing since :1971

Answered : 9988 Questions

Posted on Thu, 6 Dec 2018 in Urinary and Bladder Problems
Question: Hello
I was diagnosed with a UTI by my gynecologist about two weeks ago and given Augmentin for 7 days. On the fourth day of treatment the infection began to come back. I finished the entire course of the medication but to no avail it returned. Went to a urologist the next week. A culture came back as Proteus Mirabilis. I have bad reactions to all the antibiotics that were listed to fight the infection. I cannot take Levaquin nor Bactrim. The only other option was for me to take Gentamicin by IV or my urologist told me that because Gentamicin is such a dangerous antibiotic he could prescribe me the Bactrim and Benadryl to combat the allergy, but it was completely up to me. I decided to try the Bactrim with Benadryl. After only one pill I ended up in the ER with a rash from head to toe, low grade fever, and heart palps. ER doctor told me to never take Bactrim again and just by looking at the sample I left him my urine didn't appear very infected. He did a urinalysis and he says that it didn't come back with trace bacteria, but he would send for a culture anyway and call me in two days. He told me that the only other drugs available to treat Proteus was through an IV and I only had a simple UTI as confirmed by the lab report I gave him from my urologist. He said that he doesn't recommend me do an IV drip of the Gentamicin. He gave me a prescription for steroids and told me to stay hydrated. They did give me fluids while there and Benadryl and Pepcid through IV while in ER. I kept having to urinate while there. I called and followed up with my urologist the next day and asked him if we were going to wait on the culture from the ER and should I take the steroids prescribed because my urologist refused to prescribe steroids with the Bactrim. He said that is not something he advises with a UTI. He told me that I need to do the Gentamicin IV asap.
Before I took the Bactrim I was having abdominal cramps, pain on both my sides and back, and some pelvic pain. My muscles were twitching throughout the night and I couldn't really sleep. One night I woke up and my tongue had went numb and heart was racing. I went to an express clinic where the doctor there told me that it was probably due to the infection. That's when I decided to do the Bactrim with the Benadryl as prescribed by my urologist because the express clinic physician stated the Gentamicin is really a big gun for a UTI, but if nothing else was working I needed to make a decision before it became serious.
1. The issues I had with the muscle twitching and tongue and the pain before starting Bactrim, could it be due to the infection of Proteus? I had not had a fever until after taking one pill of the Bactrim.
2. The express clinic physician and the ER doctor seemed concerned about the Gentamicin option, but it seemed to be the only option.
3. Why didn't my urine show trace bacteria in the ER but with all of the symptoms I was having like burning when I urinate, cramping, and smelly urine was present when I gave sample to my urologist only a week before hand. And while in the ER, I was clearly urinating frequently, my bladder didn't seem to always completely empty.
4. Why would ER doctor send for a culture if the urinalysis didn't show a trace of bacteria. Why would he instruct me to drink plenty of water, almost suggesting that I need to flush my system. And he said my urine upon appearance didn't look really infected. I was clearly having UTI symptoms and the culture a week prior did show Proteus Mirabilis. One pill of Bactrim couldn't have wiped out an infection that swiftly no?

Answered by Dr. P. T. Patil 4 hours later
Brief Answer:

Clear appearance of urine on the naked eye does not rule out UTI.

Detailed Answer:


Based on the facts that you have uploaded there is no doubt that you have UTI.

Due to organisms called Proteus Mirabilis.

Clear appearance of urine as seen on the naked eye does not rule out UTI.

It takes 48-72 hours for bacteria to grow and appear in culture medium to confirm their nature and antibiotic sensitivity pattern and that is the reason urine culture is asked for so that one can take the appropriate antibiotic to eradicate the infection.

In a given situation, If you were my patient, I would suggest you to either take Meropenem by the intravenous route.

It is commonly indicated in a situation when bacteria are resistant to common antibiotics being prescribed to treat UTI.

It is comparatively safe and highly effective in UTI.

Hope I have answered your query.

Take care


Dr. P. T. Patil,
Above answer was peer-reviewed by : Dr. Arnab Banerjee

The User accepted the expert's answer

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