Bacteria in Your Urine but No UTI Symptoms?Why Guidelines Usually Say Skip the Antibiotics
Bladder & Pelvic FloorArticleA urine test can grow bacteria even when you feel fine. After menopause this is common, and the Infectious Diseases Society of America recommends against testing for it or treating it in healthy women, women with diabetes and older adults, with a few key exceptions. Here is when antibiotics help and when they mostly add risk.
In this article
Maybe a urine test was done at a checkup, before a procedure, or after a fall, and it came back positive for bacteria. You don’t have burning, urgency or fever. Do you need an antibiotic?
Who guidelines say should not be tested or treated
The Infectious Diseases Society of America (IDSA)1 recommends against screening for or treating it in:1
- Healthy women before or after menopause (strong recommendation)
- People with diabetes (strong recommendation)
- Older adults living at home who have functional limits, and residents of long-term care
The confusion and falls question
When an older person with memory or mobility problems becomes confused or falls and the urine grows bacteria, an antibiotic is often the reflex. IDSA instead recommends looking for other causes and watching closely, as long as there are no urinary symptoms and no fever or other signs of a serious infection.1
That advice weighs the risks of antibiotics, including C. difficile diarrhea, resistant bacteria and drug side effects.1 Unneeded treatment of this finding is a major source of inappropriate antibiotic use.1
When treatment is recommended
- Pregnancy1
- Before certain urologic procedures that can injure the lining of the urinary tract1
- Fever or signs of serious infection with no other clear source, which call for prompt treatment1
What this means for you
- Report symptoms clearly. New burning, urgency, frequency, fever or flank pain point to a UTI. Our guide to UTI symptoms explains the signs.
- Ask why a urine test is being ordered if you feel well.
- Be cautious with home strips. Our article on home UTI test strips explains false alarms.
- For a parent in care, ask what else has been checked before an antibiotic for confusion.
For recurring true UTIs, our guides to cranberry and methenamine cover prevention.
Try: “My urine culture grew bacteria, but I have no symptoms. Do the guidelines say I need treatment, or can we watch it?”
Laugh, Sneeze, Jump includes an appointment prep sheet. Use it to note your exact bladder symptoms and when they started before a urine test is discussed.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. Please don't stop an antibiotic you've been prescribed without talking to your clinician. Burning with urination, new urgency or frequency, fever, chills, back or side pain, vomiting, or blood in the urine need prompt medical care. If you think you may be having a medical emergency, call 911 or your local emergency number right away. This article discusses a clinical guideline. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Infectious Diseases Society of America, 2019Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America (opens in a new tab)abcdefghij
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