What is the treatment for a urinary tract infection with leukocytes and epithelial cells in the urine?

Treatment for Urinary Tract Infection with Leukocytes and Epithelial Cells in Urine

For a urinary tract infection with leukocytes and epithelial cells in the urine, treat with a first-line antibiotic such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, based on local antibiogram patterns, for a short duration of 3-7 days. 1

Diagnostic Confirmation

Before initiating treatment, it's important to understand what the presence of leukocytes and epithelial cells indicates:

• Leukocytes (WBCs): Presence of leukocytes suggests inflammation in the urinary tract, which is a key indicator of UTI 1
• Epithelial cells: While epithelial cells are normally found in urine, higher counts may indicate sample contamination or urinary tract inflammation 2

For proper diagnosis:

1. Obtain urine culture before starting antibiotics - This is crucial as antibiotics will rapidly sterilize the urine and obscure diagnosis 1
2. Positive urinalysis criteria include:
   • Positive leukocyte esterase or nitrites on dipstick
   • Microscopy positive for white blood cells or bacteria 1
3. Confirmation of UTI requires both:
   • Abnormal urinalysis (inflammation)
   • Positive urine culture (≥50,000 CFU/mL) 1

Treatment Algorithm

First-Line Antimicrobial Therapy

1. Choose one of these first-line agents based on local resistance patterns 1:

   • Nitrofurantoin 100mg twice daily for 5-7 days
   • Trimethoprim-sulfamethoxazole 160/800mg twice daily for 3-5 days 3
   • Fosfomycin 3g single dose

2. For pyelonephritis or complicated UTI, consider:

   • Ciprofloxacin 500mg twice daily for 7 days 1, 4
   • Cephalosporins based on local susceptibility patterns

Treatment Duration

• Uncomplicated UTI: Treat for as short a duration as reasonable, generally no longer than 7 days 1
• Complicated UTI: May require longer therapy based on clinical response

Special Considerations

• Adjust therapy based on culture and sensitivity results when available 1
• For resistant organisms: Consider parenteral antibiotics for as short a course as reasonable 1
• For recurrent UTIs: Consider patient-initiated treatment (self-start) while awaiting culture results 1

Follow-up

1. Clinical improvement should be seen within 48-72 hours of starting appropriate therapy 5
2. No routine post-treatment cultures are needed if symptoms resolve 1
3. For persistent symptoms:
   • Reassess with urinalysis and culture
   • Consider imaging to rule out complications or anatomical abnormalities 1

Important Caveats

• Avoid testing for asymptomatic bacteriuria - Do not perform surveillance urine cultures in asymptomatic patients 1
• Avoid treating asymptomatic bacteriuria - This can contribute to antimicrobial resistance 1
• High epithelial cell counts may indicate improper collection technique or contamination, but treatment should still be based on clinical symptoms and confirmed infection 2, 6
• Flow cytometry shows that WBC counts correlate well with the presence of common UTI pathogens like E. coli and Klebsiella 2

Remember that proper specimen collection is essential for accurate diagnosis, and antimicrobial therapy should be targeted based on local resistance patterns to minimize the development of resistant organisms.