Unblinded Empiric Antibacterial Treatment for Women with

AUTHORS: LCDR Kristina Polk, MD, CDR Michael Juliano, MD, Naval Medical Center Portsmouth.
Kristina.polk@med.navy.mil, 757-390-6720, Resident
TITLE: Empiric Antibacterial Treatment for Women with Uncomplicated Lower Urinary Tract
OBJECTIVES: Urinary tract infection (UTI) is one of the most common clinical diagnoses in
women, requiring antibacterial treatment for 1 in 3 women by age 24. Cystitis (lower UTI) is
generally considered a benign condition with no long term sequelae. In this Emergency
Department, about 10-12 patients are diagnosed with an uncomplicated lower UTI daily. The
typical ED course for a patient presenting with symptoms consistent with simple UTI includes
collection of a urine specimen, microscopic lab analysis, and frequently a urine culture and
pelvic exam. These tests are time consuming and costly. Our study used an algorithm to
empirically treat women with symptoms classically consistent with an uncomplicated lower UTI,
and who were lacking symptoms of complicated or serious genitourinary diagnoses.
METHODS: Between June 2012 and September 2013, 115 subjects were enrolled and
empirically treated with Macrobid and Pyridium without urine collection or laboratory testing.
Subjects were contacted 3 and 30 days after enrollment and polled on symptom resolution, need
for additional medical visits, medication changes, adverse events, and patient satisfaction.
RESULTS: All patients reported improvement on Day 3, with 86% reporting complete symptom
resolution. The most common complication was recurrent UTI (8%). Only three patients were
later diagnosed with other genitourinary conditions (2 urolithiasis, 1 PID). Patient satisfaction on
a 1-10 scale averaged 9.7.
CONCLUSION: We found that our algorithm could be used to safely and efficiently treat
women with symptoms of uncomplicated lower UTI. Furthermore, we found that patient
satisfaction was extremely high using this treatment algorithm.