The Impact of Empirical Management of Acute Cystitis on Unnecessary Antibiotic Use

Abstract

Empirical antibiotic treatment of acute cystitis in women without testing for pyuria promotes unnecessary antibiotic use. A simple decision rule provides for prompt treatment of infected women while reducing antibiotic overuse and unnecessary urine testing.

Diagnostic approach to urinary tract infections in male general practice patients: a national surveillance study

“…2,3 The rationale of these studies is to provide clinicians with a clinical decision rule to improve the quality of UTI care. 4,5 McIsaac et al have shown that the application of a simple diagnostic algorithm can result in the correct treatment of most females with UTI and can reduce unnecessary urine culture testing and antibiotic prescriptions. 5 Comparable studies of UTI predictors have seldom been performed for male general practice patients.…”

“…4,5 McIsaac et al have shown that the application of a simple diagnostic algorithm can result in the correct treatment of most females with UTI and can reduce unnecessary urine culture testing and antibiotic prescriptions. 5 Comparable studies of UTI predictors have seldom been performed for male general practice patients. As a consequence, guidelines for diagnosis and treatment of UTI in males are mainly based on female studies, although one can question whether the generalisation of these criteria to males is valid due to the clear genito-urinary differences.…”

“…7 In addition to the development of a diagnostic algorithm, the potential gain in the quality of UTI care to be attributed to the use of the newly developed rule needs to be assessed in clinical practice. 5 For these reasons, the study developed a diagnostic UTI algorithm using clinical information and dipstick results from Dutch male general practice patients with symptoms indicative of UTI. The study also assessed the potential impact of the newly developed diagnostic UTI algorithm by comparing its medical decisions, that is, prescription of antimicrobial therapy, with usual care.…”

“…13 Potential impact of diagnostic algorithm: comparison of predicted care with usual care The potential impact of the diagnostic algorithm was determined by comparing the sensitivity and specificity of the algorithmdriven prescription strategy with care as usual. 5 Sensitivity was defined as the proportion of males with a microbiologically-confirmed UTI for whom an antimicrobial prescription was recommended. Specificity was defined as the proportion of males without a microbiologically-confirmed UTI for whom an antimicrobial prescription was not recommended.…”

Current Management Strategies for Uncomplicated and Complicated Cystitis

“…Therefore, urine culture remains the definitive diagnostic investigation for acute cystitis and the presence of 10 2 cfu/mL or more of urine indicates active infection. Admittedly, routine urine culture is not always necessary for diagnostic purposes (McIsaac et al 2002). It is considered more cost-effective to manage and treat patients symptomatic of uncomplicated cystitis without an initial urine culture because antimicrobial therapy is often completed before culture results are made available.…”