Treating Uncomplicated Cystitis

Kiran Panesar, BPharmS (Hons), MRPharmS, RPh, CPh

Disclosures

US Pharmacist. 2013;38(8):34-37. 

In This Article

Diagnosis

Dipstick testing detects nitrites and leucocyte esterase as a means of screening for UTIs. Nitrites are found in urine as a result of breakdown of nitrates by bacteria and are therefore not present in normal urine. Leucocyte esterase is released from neutrophils that are attracted to the infected area.[10] While a dipstick has a high negative predictive value allowing UTIs to be excluded with confidence, it has a relatively low predictive positive value.[10] In patients who are at high risk of contracting a UTI, a negative urine dipstick test does not rule out the possibility of an infection.[11] Furthermore, this method is unreliable in pregnant women and in children <3 years of age.[10]

The culture of a urine specimen is the most accurate way of diagnosing a UTI, although it takes longer than a dipstick test.[10] Microscopic analysis may also be used to reveal pathogens present in the urine.[11]

At-home tests such as Azo Test Strips also detect nitrites and leukocytes. They are useful for early detection of UTIs in patients who experience recurrent UTIs.[12] Patients should be informed that false negatives may occur in those taking tetracycline or in strict vegetarians who do not consume sufficient nitrates. Additionally, patients who test within 24 hours of consuming >500 mg of vitamin C may get a false negative, as the ascorbic acid interferes with the test. Using the test strips during the menstrual cycle will result in a false-positive result.[12]

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