UTIs almost always start mild. The trouble is that once they're brewing, they get worse faster than people expect — and an evening of "I'll just wait until morning" can turn into a 2 am ED visit with rigors and back pain. Catching one tonight is one of the genuine cases where same-night care changes the trajectory of the illness.
Classic UTI symptoms
- Burning or stinging on passing urine (dysuria)
- Frequency — going to the toilet far more often than usual, often with small volumes
- Urgency — a sudden, hard-to-defer need to go
- Suprapubic discomfort — a dull ache or pressure in the lower abdomen
- Cloudy or smelly urine, sometimes with a pink tinge
You don't need all of these. The first three together are essentially diagnostic in an otherwise healthy adult woman.
Why women, men and children get UTIs differently
In adult women, UTIs are common and usually uncomplicated. In adult men, UTIs are uncommon and almost always warrant investigation for an underlying cause (prostate, structural). In children, especially infants, UTIs can be subtle and serious — we treat all paediatric UTIs as warranting same-night assessment.
The two questions we always ask
Before we prescribe anything, we ask:
- Could you be pregnant? Pregnancy changes our antibiotic choice (we avoid trimethoprim in the first trimester and nitrofurantoin at term). An untreated UTI in pregnancy also has obstetric implications, so we lower our threshold for prescribing.
- Are you systemically unwell? Fever, shaking chills, vomiting, severe back or flank pain — these suggest the infection has moved up to the kidneys (pyelonephritis), and that is hospital-level care, not after-hours-clinic care.
Our in-clinic workup
Most uncomplicated UTI visits take about 20 minutes:
- Brief targeted history (symptoms, duration, pregnancy, previous UTIs)
- Vitals — temperature, blood pressure, heart rate
- Abdominal examination, including for flank tenderness
- Urine dipstick in the clinic (leucocytes, nitrites, blood, protein)
- Mid-stream urine sent to pathology for culture and sensitivity (results back to your GP in 1–2 days)
- First dose of antibiotic and a written script for the remainder
First-line antibiotics in 2026
For uncomplicated UTI in a non-pregnant adult, we typically prescribe:
- Trimethoprim 300 mg once daily for 3 days, or
- Nitrofurantoin 100 mg twice daily for 5 days
Pregnant patients receive cefalexin or nitrofurantoin depending on gestation. We follow current Therapeutic Guidelines: Antibiotic recommendations, and we use the urine culture result to confirm or adjust treatment if needed.
When a UTI tips into pyelonephritis
If you have any of the following alongside UTI symptoms, please go to ED rather than us:
Red flags suggesting pyelonephritis
- Temperature 38.5°C or higher
- Shaking chills (rigors)
- Vomiting that won't stop
- Severe pain in the back or flank (loin pain)
- Confusion, particularly in older adults
- Pregnancy with any of the above
Pyelonephritis usually needs IV antibiotics and observation — not something we can do after hours.
Why not just wait until morning?
Two reasons. First, you'll spend a miserable night with frequency and pain that an antibiotic would have started to settle by sunrise. Second, the risk of the infection ascending to the kidneys rises with every hour of untreated bacteriuria. Most of the patients who end up admitted to hospital for pyelonephritis spent the previous 24 hours hoping it would settle on its own.