From the Guidelines
Treatment for Asymptomatic Bacteriuria (ASB)
Treating asymptomatic bacteriuria is generally not recommended in most cases, as it can lead to unnecessary antibiotic use and contribute to antibiotic resistance 1. However, there are certain exceptions where treatment may be considered, such as in pregnant women or individuals undergoing urologic procedures.
Exceptions for Treatment
- Pregnant Women: Treatment with antibiotics such as Nitrofurantoin (100 mg orally twice a day for 5 days) or Cephalexin (500 mg orally three times a day for 5 days) is recommended to prevent complications 1.
- Urologic Procedures: A single dose of an antibiotic such as Ciprofloxacin (500 mg orally) or Levofloxacin (500 mg orally) may be considered 30 minutes to 1 hour before the procedure 1.
General Approach
In general, asymptomatic bacteriuria in healthy individuals does not require treatment, and a watchful waiting approach is recommended 1. It is essential to consult with a healthcare provider to determine the best course of action based on individual circumstances.
Key Points
- Asymptomatic bacteriuria is common in certain populations, such as individuals with spinal cord injuries, but treatment is not recommended unless symptoms develop 1.
- The Infectious Diseases Society of America and other organizations recommend against treating asymptomatic bacteriuria in most cases, except for pregnant women and individuals undergoing urologic procedures 1.
- Antibiotic resistance is a significant concern, and unnecessary use of antibiotics should be avoided 1.
From the Research
Treatment of Asymptomatic Bacteriuria (ASB)
The treatment of ASB varies depending on the patient group and the presence of certain risk factors.
- In general, treatment of ASB is not recommended for patients without risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalized patients, patients with renal transplants, or patients prior to joint replacement, as it may be harmful and lead to antimicrobial resistance 2, 3, 4.
- However, treatment of ASB is recommended for pregnant women, as it can decrease the risk of symptomatic UTI, low birthweight, and preterm delivery 2, 3, 4.
- Treatment of ASB is also recommended prior to transurethral resection surgery, as it can reduce the risk of postoperative UTI 2, 5.
- In patients with recurrent UTIs, treatment of ASB may not be necessary and may even play a protective role in preventing symptomatic episodes, particularly when Enterococcus faecalis has been isolated 5, 6.
- The Infectious Disease Society of America (IDSA) updated its asymptomatic bacteriuria management guidelines in 2019, emphasizing the risks and benefits of treating the condition and recommending treatment only when there is evidence of potential benefit 3.
Patient Groups
The following patient groups have specific recommendations for the treatment of ASB:
- Pregnant women: treatment is recommended in the first trimester if ASB is detected 3.
- Patients undergoing endoscopic urologic procedures: treatment is recommended prior to the procedure if ASB is detected 3.
- Patients with recurrent UTIs: treatment of ASB is not recommended, as it may play a protective role in preventing symptomatic episodes 5, 6.
- Patients with diabetes, neutropenia, spinal cord injuries, indwelling urinary catheters: treatment of ASB has not been found to improve clinical outcomes and is not recommended 3, 4.