From the Guidelines
The management of a patient with high epithelial and pus cell levels in a urine routine test, suggestive of a urinary tract infection (UTI), typically involves empiric antibiotic therapy while awaiting urine culture results, with first-line treatment including nitrofurantoin 100mg twice daily for 5 days, as recommended by the most recent guidelines 1. The choice of antibiotic should be based on the patient's medical history, potential allergies, and local resistance patterns, as well as the severity of the infection.
- For uncomplicated UTIs, nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin are commonly used options, with the specific choice depending on factors such as the patient's renal function and the presence of any underlying medical conditions 1.
- For patients with complicated UTIs, a combination of antibiotics such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, may be necessary, as outlined in the European Association of Urology guidelines 1. It is essential to note that the presence of epithelial cells in the urine may indicate contamination during collection or inflammation of the urinary tract lining, and a follow-up urinalysis after completing antibiotics is recommended to ensure resolution of the infection.
- Patients should also be advised to increase their fluid intake to help flush bacteria from the urinary tract and may take phenazopyridine to relieve dysuria symptoms, as suggested by previous studies 1. If fever, flank pain, or systemic symptoms are present, the patient should be evaluated for pyelonephritis, which requires more aggressive treatment, and imaging studies may be necessary to detect any underlying anatomical abnormalities or complications, as recommended by the ACR Appropriateness Criteria 1.
From the FDA Drug Label
To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Urinary Tract Infections For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris Adult Patients: Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis
The management for a patient with high epithelial and pus cell levels in a urine routine test, suggestive of a urinary tract infection (UTI), is to treat with an antibacterial agent.
- Treatment options include sulfamethoxazole and trimethoprim tablets 2 or Ciprofloxacin Tablets USP 3.
- Urinary Tract Infections should be treated with a single effective antibacterial agent rather than a combination.
- The choice of antibacterial agent should be based on the susceptibility of the bacteria and local epidemiology and susceptibility patterns.
From the Research
Management of High Epithelial and Pus Cell Levels in Urine Routine Test
- High epithelial and pus cell levels in a urine routine test are suggestive of a urinary tract infection (UTI) 4, 5, 6, 7, 8.
- The management of UTI typically involves the use of antimicrobial agents, such as sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid 4.
- Nitrofurantoin is a commonly used antibiotic for the treatment of uncomplicated lower urinary tract infections, and it has been shown to be effective in achieving clinical and microbiologic resolution 5, 6, 7, 8.
- The choice of antibiotic should be based on the severity of the infection, the presence of any underlying medical conditions, and the susceptibility of the causative organism to the antibiotic 4, 5, 6, 7, 8.
Treatment Options
- Nitrofurantoin is a reasonable alternative to trimethoprim-sulfamethoxazole and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens 7.
- A 5-day course of nitrofurantoin has been shown to be more effective than a single dose of fosfomycin in achieving clinical and microbiologic resolution of uncomplicated lower urinary tract infections in women 5.
- Nitrofurantoin has also been shown to be effective in preventing UTIs, with a risk ratio of 0.38 in favor of nitrofurantoin compared to no prophylaxis 6.