Q: I am a 28 years old woman having frequent and painful urination and severe pain in pelvic region. I got a urine analysis done, it showed albumin and 10-12 pus cells in the urine. No other abnormality was noted. The doctor suggested Cefolac 200. There is no trace of bacteria. Should I take the medicine as I am still breastfeeding my a year old baby? Is it possible that it is not an infection and rather something else?

A:Pyuria signifies abnormal numbers of white blood cells (WBCs) in the urine, usually detected under microscope in an unspun sample. Everybody's urine would contain these cells in certain amount, up to 5 WBCs in males and up to 10 in females are considered normal. Any irritation of urinary system lining will cause an increase in number of these cells. Acute urinary tract infection is the most common cause and is associated with urinary symptoms, and a positive urinary culture. Antibiotics such as penicillins, cephalosporins and macrolides are considered to be compatible with breastfeeding although there are theoretical risks of alterations to infant bowel flora and allergic sensitisation. This is not uncommon to continue with pyuria for some days even after an acute infection has settled with treatment, though culture at this time may be negative. If you do not have symptoms and the culture is negative, the pyuria does not require treatment with antibiotics. There is a significant other group of diseases, which cause persistent pyuria even in absence of an acute infection, or a positive urine culture. The phenomenon is called sterile pyuria. While infections with organisms, which cannot be grown on normal culture plates (like tuberculosis) forms one group, the other group is of non-infective origin. Common non-infective causes are urinary stones and non-infective inflammations like interstitial cystitis. Rarely, some cancers like carcinoma-in-situ also lead to pyuria and need to be excluded in cases with persistent pyuria.