Hesperian Health Guides

Urinary Infections

Persons with spinal cord injury or spina bifida have a high risk of urinary (bladder) infections, for the reasons we have discussed. Long-term or untreated infections and kidney problems are a common cause of early death. Preventive measures are essential (see the bottom of the next page); but even when precautions are taken, some urinary infections are still likely to happen. Therefore, it is very important to recognize the signs and provide effective treatment.


When a person who has normal feeling has a urine infection, it burns when he pees. The person with spinal cord damage may not feel this burning and therefore has to use other signs to know when he has an infection. He may learn to recognize certain unpleasant feelings, or may only know that he does not feel as healthy as usual. Parents and health workers should learn to listen to the child and be aware of changes in behavior or other signs that might mean that he has an infection.

Possible urinary signs

  • cloudy urine, possibly with pieces of mucus, pus, or blood specks
  • dark or red urine
  • strong or bad smelling urine
  • increased bladder spasms (cramps)
  • increased wetting or changes in bladder function
  • pain in the mid-back (kidneys) or side (urine tubes)

Possible other signs

  • body aches
  • general discomfort
  • increased muscle spasms
  • fever
  • dysreflexia (headache, goosebumps when sweating, high blood pressure)

At the first signs of infection, drink even more water than usual. Antibiotics (medicines that fight bacteria) may also be necessary. But avoid frequent use of antibiotics because they may become less effective (bacteria may become resistant).

If a person has had many urinary infections before, take the person to a medical laboratory for a ‘culture’ and ‘sensitivity test’ of the urine. If possible, consult a specialist in urinary problems. If this is not possible, start with the last medicine that was effective.

In patients with a first infection:

  • Start with one of the medicines in Group 1 below. After 2 days, if the person does not begin to improve, try another medicine in Group 1.
  • If none of the medicines of Group 1 help, try the medicine in Group 2.
  • If a medicine seems to help, continue taking it for at least a week, or for 3 days after the last signs have disappeared. Do not change from one medicine to another unless the medicine is not working or causes serious side effects.


Medical name (and common brand) Age Dose Repeat the dose
A. Co-trimoxazole
(sulfamethoxazole 400 mg. with trimethoprim 80 mg.)
(Bactrim or Septra)
6 weeks to 5 months ¼ tablet 2 times a day
6 months to 5 years ½ tablet
6 to 8 years 1 tablet
9 years and older 2 tablets
Note: This medicine can cause kidney damage unless the person drinks lots of water. The medicine also comes in double strength (Bactrim DS and Septra DS). Adjust tablet doses if using double strength tablets.
B. Amoxicillin (many brands)
(100 mg/kg/day)
under 2 years 125 mg 3 times a day
2 to 10 years 250mg
over 10 years 250 to 500 mg
CAUTION! Do not use for persons allergic to penicillin
C. Nitrofurantoin (Furadantin, Macrodantin) (from 3 months:
5 to 7 mg/kg/day)
1 month to 5 years 25mg 4 times a day
over 6 years 50 mg
Cephalexin (Keflex)
(25 to 50 mg/kg/day)
4 months to 1 year 62 mg 4 times a day
1 to 4 years 125 mg
5 to 12 years 250 mg
All persons with a urinary infection should always drink lots of water, especially while they are taking medicine. Keep taking medicine until the infection is gone for 3 days, continue drinking lots of water, and take all preventive measures.


child drinking water from glass
To prevent urinary infections, drink
  • Drink lots of liquid: adults, at least 2 liters (8 glasses) a day.
  • Eat apples, grapes, or cranberries or drink their juices or take vitamin C tablets to make urine more acid. Bacteria grow with more difficulty in acid urine.

Note: Orange or lemon juice and other citrus fruits and juices do not work! They make the urine less acid.

  • Keep hands, catheter, and collection bags very clean before, during, and after your bladder program.
  • Do not lie in bed all day. Stay active.
  • Do not clamp the Foley catheter or plug it with anything unless absolutely necessary, then use a sterile plug.
  • Stick to your bladder program. Do not allow urine to sit in bladder.
  • Do not let the catheter get bent or twisted so that urine cannot come out.
  • If using a standard catheter periodically, be sure to put it in regularly, at least every 4 to 6 hours. To prevent infections, frequency of catheter use is even more important than cleanliness. It is safer to put in the catheter without boiling it than not to put it in. If infections are common, catheterize more often.

This page was updated:21 Nov 2019