From the Guidelines
Treatment for esterase trace and urine WBC present is not automatically required, but should be considered if accompanied by symptoms such as painful urination, frequency, urgency, or lower abdominal pain. The presence of esterase trace and white blood cells (WBCs) in urine typically indicates a possible urinary tract infection (UTI) 1. However, the decision to treat should be based on the presence of symptoms, as asymptomatic individuals may not require treatment 1. If symptomatic, a typical treatment would be antibiotics such as nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose.
- Key considerations include:
- The presence of symptoms such as dysuria, frequency, urgency, or lower abdominal pain
- The results of a proper urine culture to identify the specific bacteria and appropriate antibiotic
- The potential for contamination or non-infectious causes of esterase trace and WBCs in urine
- The importance of considering the individual's overall health status, including any underlying medical conditions or frailty 1. According to the most recent guidelines, fluoroquinolones and cephalosporins are the only antimicrobial agents that can be recommended for oral empiric treatment of uncomplicated pyelonephritis 1. However, the choice of antibiotic should be tailored to the individual's specific needs and the results of the urine culture.
From the Research
Treatment for Esterase Trace and Urine WBC Present
- The presence of esterase trace and urine WBC (white blood cell) indicates a potential urinary tract infection (UTI) 2.
- According to a study published in the Journal of Pediatric Emergency Care, a positive urinalysis (UA) result, which includes the presence of leukocyte esterase, is associated with an increased likelihood of a UTI caused by Escherichia coli (E. coli) 2.
- However, the same study found that a negative UA result does not rule out a UTI, and in such cases, the infection is more likely to be caused by non-E. coli organisms 2.
- The choice of antibiotic treatment depends on the suspected causative agent and local antibiotic resistance patterns 3, 2, 4.
- For uncomplicated lower urinary tract infections, first-line treatments include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 3.
- A study published in the Journal of Urology found that using a prior culture as a guide can enhance the probability of selecting an effective empirical agent for patients with recurrent, uncomplicated cystitis 4.
Antibiotic Resistance and Treatment
- Antibiotic resistance is a growing concern, and the choice of treatment should take into account local resistance patterns 3, 4.
- Nitrofurantoin is a widely used antibiotic for treating UTIs and has been shown to be effective against common uropathogens, including E. coli 5.
- However, the use of nitrofurantoin should be guided by local resistance patterns and patient-specific factors, such as the presence of chronic UTI or elderly patients 5.