BACKGROUND: Guidelines for the management of @entity2335 support empirical antibiotic treatment; however, up to half of symptomatic @entity1 have negative urine cultures. OBJECTIVE: To determine whether empirical treatment leads to unnecessary antibiotic prescriptions in @entity1 with symptoms of @entity2335 . METHODS: A cohort of 231 @entity1 (defined as females aged 16 years and older) presenting to family physicians' offices with symptoms of @entity2335 underwent a standardized clinical assessment, urine dip testing, and culture. Recommendations for urine testing and antibiotic treatment under 3 empirical strategies were compared with observed physician management and a logistic regression model for the outcomes of antibiotic prescriptions, urine culture testing, and unnecessary antibiotics, defined as a prescription where the subsequent urine culture was negative. RESULTS: There were 123 positive urine cultures (53.3%). Physicians prescribed antibiotics to 186 @entity1 (80.9%), of whom 74 (39.8%) were culture negative. Unnecessary antibiotic use was similar for 2 guidelines recommending empirical antibiotic treatment without testing for @entity4658 (41.4% and 40.6%). Treating @entity1 with @entity2335 and @entity4658 would have decreased unnecessary antibiotic use (26.2%; P =.02) but resulted in fewer @entity1 with confirmed @entity293 receiving immediate antibiotics (66.4% vs 91.8% usual care; P<.001). A derived prediction model incorporating testing for @entity4658 and @entity2648 would also have reduced unnecessary antibiotic use (27.5%; P =.03), but more @entity1 with confirmed @entity293 would have received immediate antibiotics (81.3%; P =.01). CONCLUSIONS: Empirical antibiotic treatment of @entity2335 in @entity1 without testing for @entity4658 promotes unnecessary antibiotic use. A simple decision rule provides for prompt treatment of infected @entity1 while reducing antibiotic overuse and unnecessary urine testing.

The impact of empirical management of XXXX on unnecessary antibiotic use.

@entity1 :: ('9606', 'Species') :: ['women'] @entity4658 :: ('MESH:D011776', 'Disease') :: ['pyuria'] @entity2648 :: ('MESH:D009573', 'Chemical') :: ['nitrites'] @entity2335 :: ('MESH:D003556', 'Disease') :: ['cystitis', 'classic cystitis symptoms', 'acute cystitis'] @entity293 :: ('MESH:D014552', 'Disease') :: ['urinary tract infection']
@entity2335 :: (MESH:D003556,Disease) :: ['acute cystitis']
