Targeted, immediate antibiotics following a positive dipstick test may be the optimal management strategy.

This interesting, prospective, and randomised clinical study tested fi ve different approaches in the treatment of women suspected with uncomplicated urinary-tract infection (UTI): immediate, empirical, antibiotic therapy (AT); delayed (by 48 h), empirical AT; empirical AT offered to patients showing a certain clinical symptom score; empirical AT offered to patients with positive dipstick urinalysis; and targeted AT offered according to the results of a midstream urine microbiological culture and symptomatic treatment up to the point when the microbiological results became available. The study included 309 non-pregnant women aged between 18 and 70 years. All groups were comparable in terms of demographics, clinical characteristics and frequency of symptom severity at the time of study. The study aimed to achieve a similar-level reduction of symptoms without unnecessary antibiotic usage, laboratory investigations and reconsultations. A statistical consideration of sample size was performed for α=0.05 and β=0.2 for multiple groups. Patients with clinical symptoms who did not require immediate AT were included. The patients had access to antibiotics at their request, despite randomisation. The use of midstream urine culture and dipsticks when not indicated on the advice sheets was also assessed. The study managed to represent the clinical ambulatory situation in a general practice. According to the analysis, the authors concluded that all fi ve management strategies achieved similar (but not equivalent) symptom reduction; there was no advantage in routinely sending midstream urine samples for (microbiological) testing, and antibiotics targeted with dipsticks with a delayed prescription as backup, or empirical delayed prescription, can help to reduce antibiotic use.