Urinary tract infection (UTI)
Also called: UTI, bladder infection, cystitis, urine infection, kidney infection (pyelonephritis)
A urinary tract infection (UTI) is an infection of the bladder, urethra or kidneys, most often caused by gut bacteria. It causes burning when passing urine and needing to go often. Most bladder infections clear with a short antibiotic course; a kidney infection needs prompt care.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
A urinary tract infection (UTI) happens when germs, usually bacteria, get into the urinary system and cause inflammation (swelling and irritation). The urinary system is made up of the kidneys, the ureters (tubes from kidney to bladder), the bladder and the urethra (the tube that carries urine out of the body). An infection in the bladder is called cystitis, or a lower UTI. An infection that reaches the kidneys is called pyelonephritis, or an upper UTI, and is more serious.
UTIs are very common, especially in women. Around half or more of all women will have at least one UTI in their life, and many will have repeat infections. The usual cause is a bacterium called Escherichia coli (E. coli), which normally lives in the bowel. Bacteria travel up the urethra into the bladder. Women get UTIs more often because their urethra is shorter, so the bacteria have less distance to travel.
Most bladder infections are mild and get better with a short course of antibiotics, and in some healthy women symptoms settle on their own with fluids and pain relief. However, a UTI in a man, a pregnant woman, a young child, an older person, or someone with diabetes or a urinary catheter needs more care. Doctors also try to use antibiotics carefully, because UTI bacteria in Pakistan and elsewhere are becoming resistant to many common medicines.
In Pakistan: what studies show
Pakistan's national surveillance in 2022 found that 69.5% of E. coli germs resisted ciprofloxacin and 68.5% resisted co-trimoxazole, while in 2021 only 11% of urine E. coli resisted nitrofurantoin and 8% resisted fosfomycin. Two Karachi hospital studies found hidden urine infection in 12.4% and 17% of pregnant women.
- Pakistan's national resistance surveillance found that in 2022, 69.5% of E. coli germs resisted ciprofloxacin and 68.5% resisted co-trimoxazole; most of these germs (82%) came from urine samples.[1] (surveillance, data January - December 2022)
- In the same national surveillance in 2021, E. coli from urine samples stayed mostly sensitive to two bladder-infection medicines: only 11% resisted nitrofurantoin and 8% resisted fosfomycin.[1] (surveillance, data January - December 2021)
- National surveillance in 2021 also found that 75% of E. coli germs resisted ceftriaxone, a common injected antibiotic (this kind of resistance is often caused by enzymes such as ESBL).[1] (surveillance, data January - December 2021)
- A laboratory study of urine E. coli from patients in Faisalabad found that 48% of the germs made ESBL, an enzyme that destroys many common antibiotics.[3] (cross-sectional laboratory study, data not stated)
- In one study of 200 multidrug-resistant E. coli urine infections in Narowal in 2022, 13.5% were resistant to carbapenems, the strongest antibiotics kept for hospital use.[4] (cross-sectional, data March - August 2022)
- A review of 54 published Pakistani studies and laboratory reports from 2006-2018 found that carbapenem resistance in E. coli and Klebsiella germs stayed below 30%.[2] (systematic review of published data and laboratory antibiograms, data 2006-2018)
- One hospital study in Karachi found that 17% of pregnant women at an antenatal clinic had bacteria in their urine without any symptoms, most often E. coli.[5] (cross-sectional, data not stated (six-month study period))
- Another hospital study in Karachi in 2014-2015 found symptom-free bacteria in the urine of 12.4% of 177 women at an antenatal clinic, most often E. coli.[6] (cross-sectional, data July 2014 - September 2015)
What we do not know yet: No Pakistan national UTI treatment guideline was found in this search; the NIH surveillance report itself notes very high resistance in urine germs except to nitrofurantoin and fosfomycin. The national ciprofloxacin, co-trimoxazole and ceftriaxone figures cover E. coli from all sample types, ESBL and carbapenem data come from single-city studies (Faisalabad, Narowal), and pregnancy figures come from two small Karachi hospital studies (12.4% and 17%), so national UTI frequency in pregnancy is unknown.
Pakistan studies cited
- Ashraf Z (compiler), Ishaq S (data analysis); National Institute of Health, Pakistan National Antimicrobial Resistance (AMR) Surveillance Report Pakistan 2021-2022. National Institute of Health (NIH), Islamabad, Pakistan 2024 (web upload; publication year not stated in document; data 2021-2022). Open source
- Saeed DK, Farooqi J, Shakoor S, et al. Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006-2018. BMC Infectious Diseases 2021;21(1):1231. doi:10.1186/s12879-021-06795-0. Open source
- Ehsan B, Haque A, Qasim M, et al. High prevalence of extensively drug resistant and extended spectrum beta lactamases (ESBLs) producing uropathogenic Escherichia coli isolated from Faisalabad, Pakistan. World Journal of Microbiology & Biotechnology 2023. PMID 36959469. Open source
- Hassan SN ul, Farva K, Bhutta GA, et al. Antibiotic Resistance in Adult Patients with Urinary Tract Infection due to Escherichia Coli. Pakistan Armed Forces Medical Journal 2026;76(2):183-186. doi:10.51253/pafmj.v76i2.11764. Open source
- Qazi TN, Naseer S, Ainuddin JA Prevalence and Causative Organisms of Asymptomatic Bacteriuria among Pregnant Women in Karachi, Pakistan. Journal of the College of Community Physicians of Sri Lanka 2021;27(2):360-367. doi:10.4038/jccpsl.v27i2.8392. Open source
- Pario S, Muneeb A, Shuja S Asymptomatic Bacteriuria in Women Presenting to Antenatal Clinic at a Tertiary Care Hospital in Karachi, Pakistan. Pakistan Armed Forces Medical Journal 2018;68(5):1138-42. Open source
Symptoms
- Pain, stinging or burning when passing urine
- Needing to pass urine more often than usual, including at night
- A sudden, strong urge to pass urine, sometimes with only a small amount coming out
- Cloudy, dark or bad-smelling urine
- Blood in the urine
- Pain or pressure low in the belly, above the pubic bone
- Pain in the back or side just under the ribs, with fever, chills, nausea or vomiting (signs the infection has reached a kidney)
- In babies and young children: fever, being unusually unwell or irritable, poor feeding, vomiting, or wetting themselves again after being dry
- In older or frail people: new confusion, agitation, shivering or worse bladder control, sometimes without the usual urinary symptoms
Causes and risk factors
Causes
- Bacteria from the bowel, most often E. coli, entering the urethra and travelling up to the bladder
- Other bacteria such as Klebsiella, Proteus, Enterobacter or Staphylococcus saprophyticus
- Bacteria introduced by a urinary catheter (a tube placed in the bladder to drain urine)
- Infection spreading up from the bladder to the kidneys if a bladder infection is not treated or does not clear
What makes it more likely
- Being female, because the urethra is short and close to the back passage
- Sexual activity, and use of spermicide (a chemical that kills sperm) with condoms, diaphragms or caps
- Pregnancy
- Menopause, because hormone changes alter the natural balance of bacteria
- Anything that blocks urine flow or stops the bladder emptying fully, such as kidney stones, an enlarged prostate in men, or constipation in children
- Diabetes, especially when poorly controlled, or a weakened immune system (for example from chemotherapy or HIV)
- Having a urinary catheter, whether long-term or used now and then
- Not drinking enough fluids, holding urine in for long periods, or wiping from back to front after using the toilet
Complications
The main complication of a bladder infection is that it spreads upwards to the kidneys (pyelonephritis). A kidney infection causes fever, chills and pain in the back or side, and it can damage the kidney if not treated quickly. In some people, especially older adults and those who are already unwell, the infection can spread into the blood and cause sepsis (a dangerous whole-body reaction to infection), which can be life-threatening. In pregnancy, even bacteria in the urine without symptoms can lead to a kidney infection, early (preterm) birth and a low birth-weight baby, which is why pregnant women are screened and treated. Some people get repeated UTIs, which can affect daily life and increase the chance of antibiotic resistance.
When to see a doctor
- Fever with shivering, or feeling very hot or very cold, together with urinary symptoms
- Pain in the back or side under the ribs, or nausea and vomiting, which may mean a kidney infection
- Symptoms that get much worse quickly, or do not improve within 48 hours of starting an antibiotic
- New confusion, drowsiness or difficulty speaking, especially in an older person: this is an emergency, go to the nearest hospital or call an ambulance
- A UTI in a baby or child, a pregnant woman, a man, or someone with diabetes, a weak immune system or a catheter
- Blood in the urine that does not clear after treatment
- Two or more UTIs in six months, or three or more in a year
Diagnosis
In a healthy, non-pregnant woman with the typical symptoms, a doctor or pharmacist can often diagnose a bladder infection from the symptoms alone. Two or more key urinary symptoms, with no other explanation, are usually enough, and a urine dipstick test is not always needed. A dipstick (a paper strip dipped in urine that changes colour) can help when the picture is unclear. Dipstick tests are not used to diagnose UTI in people with a long-term catheter, because their urine often contains bacteria anyway.
A mid-stream urine sample is sent to the laboratory for culture (growing the bacteria) and sensitivity testing (checking which antibiotics work) before antibiotics are started in men, pregnant women and children, and in anyone whose symptoms do not settle or who keeps getting infections. The result helps the doctor change the antibiotic if the bacteria are resistant. If a kidney infection or a blockage is suspected, blood tests and an ultrasound or other scan may be needed. Bacteria found in the urine of someone with no symptoms (asymptomatic bacteriuria) is usually not treated, except in pregnancy.
Treatment
- Drink enough fluids and use a simple painkiller such as paracetamol (or ibuprofen if it is safe for you) to ease pain and fever.
- For a mild bladder infection in a healthy, non-pregnant woman, the doctor may offer an immediate antibiotic or a 'back-up' prescription to start only if symptoms have not improved after 48 hours or get worse.
- Men, pregnant women and children are given an antibiotic straight away, and a urine sample is sent for culture first so the choice can be checked.
- The doctor chooses a narrow-spectrum antibiotic (one that targets a limited range of bacteria), such as nitrofurantoin, using local resistance patterns and any previous urine results. Your doctor decides the medicine, the dose and how long to take it.
- If symptoms are not better after 48 hours, or the laboratory shows the bacteria are resistant, the doctor switches to a different antibiotic guided by the culture result.
- A kidney infection, or any UTI with signs of serious illness, is treated with different antibiotics, sometimes in hospital through a drip.
- People with repeated UTIs are reviewed for causes, and the doctor may suggest a long-term preventive antibiotic or, after menopause, a vaginal oestrogen product.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Nitrofuran antibiotics | usual first choice for a bladder infection in women, men and children; also used in pregnancy, but avoided near delivery and when kidney function is low | Nitrofurantoin (5 brands) |
| Trimethoprim | first-choice alternative when local resistance is low and recent urine results allow; not used in pregnancy | Trimethoprim (7 brands) |
| Fosfomycin | second-choice single-dose option for women when the first antibiotic fails or is unsuitable; it remains active against many resistant E. coli | Fosfomycin (12 brands) |
| Penicillins and cephalosporins | second-choice options in pregnancy and in children, with amoxicillin used only when the laboratory shows the bacteria are sensitive to it | Amoxicillin (248 brands), Cephalexin (173 brands) |
| Painkillers | relieve pain and fever while the infection clears; they do not treat the infection | Paracetamol (350 brands), Ibuprofen (378 brands) |
Also used (not yet in our price list): pivmecillinam (a penicillin-type antibiotic used as a second choice in women)
Self-care and prevention
Self-care
- Drink enough water to keep your urine pale, and rest while you recover.
- Take paracetamol for pain or fever as your doctor or pharmacist advises.
- Avoid drinks that irritate the bladder, such as coffee, alcohol and large amounts of fruit juice, until you feel better.
- Do not hold urine in; go to the toilet as soon as you need to and take your time to empty the bladder.
- If you are given an antibiotic, finish the course even if you feel better after a day or two.
- If you are given a back-up prescription, start it only if symptoms have not improved after 48 hours or get worse.
- Cranberry drinks and cystitis sachets have not been shown to treat an infection that has already started, so do not rely on them instead of seeing a doctor.
Prevention
- Drink plenty of fluids, mainly water, through the day.
- Wipe from front to back after using the toilet, and keep the genital area clean and dry without scented soaps.
- Pass urine soon after sex, and wash the area with water before and after.
- Avoid spermicides and spermicide-coated condoms if you get repeated UTIs; talk to your doctor about other contraception.
- Change wet nappies and incontinence pads promptly, and wear loose cotton underwear.
- If UTIs keep coming back, see your doctor: a preventive antibiotic, or vaginal oestrogen after menopause, may be advised.
Common questions
Can a UTI go away on its own?
A mild bladder infection in a healthy woman sometimes clears with fluids and painkillers, which is why a doctor may give a back-up prescription to use only if needed. But if symptoms last more than 48 hours, get worse, or you have fever or back pain, you need an antibiotic. Men, pregnant women and children should always be treated.
Why does my doctor want a urine culture before giving antibiotics?
A culture shows exactly which bacteria are causing the infection and which antibiotics can kill them. This matters in men, pregnant women, children and anyone with repeat infections, because resistance is common. Antibiotics can be started while waiting for the result and changed if needed.
Why do women get UTIs more than men?
A woman's urethra is short and sits close to the back passage, so bowel bacteria can reach the bladder easily. Sex, pregnancy, spermicides and menopause add to the risk. Men get UTIs less often, but when they do, an enlarged prostate or another problem is often involved, so a man with a UTI should always see a doctor.
Is blood in the urine with a UTI dangerous?
A little blood in the urine is common with a bladder infection and usually clears with treatment. If blood is still there after the infection has gone, or you have no other UTI symptoms, see your doctor, because it needs to be checked for other causes.
What is the difference between a bladder infection and a kidney infection?
A bladder infection (cystitis) causes burning, urgency and frequent urination but no fever. A kidney infection (pyelonephritis) causes fever, chills, nausea and pain in the back or side, and it is more serious. A kidney infection needs prompt medical care and sometimes hospital treatment.
Sources
- NICE. Urinary tract infection (lower): antimicrobial prescribing (NICE guideline NG109) - Recommendations (2018).
- NICE. Urinary tract infection (lower): antimicrobial prescribing - NICE guideline NG109 (PDF) (2018).
- CDC. Clinical Overview of Urinary Tract Infections | UTI | CDC (2026).
- NHS. Urinary tract infections (UTIs) (2025).
- NICE. New NICE quality standard identifies improvements in urinary tract infection diagnosis for women (2023).
- World Journal of Microbiology and Biotechnology (PMC). High prevalence of extensively drug resistant and extended spectrum beta lactamases (ESBLs) producing uropathogenic Escherichia coli isolated from Faisalabad, Pakistan (2023).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.