Do you have to repeat urinalysis after 1 week of antibiotics (ABX)?

Routine Repeat Urinalysis After Antibiotics for Uncomplicated UTI is Not Necessary

For uncomplicated urinary tract infections in asymptomatic patients, you do not need to repeat urinalysis or urine culture after completing antibiotic therapy—symptom resolution is sufficient evidence of cure. 1

When Repeat Testing is NOT Indicated

• Asymptomatic patients after treatment completion do not require routine post-treatment urinalysis or urine cultures, as this practice can lead to overtreatment of asymptomatic bacteriuria 1
• Symptom clearance alone is adequate evidence of successful treatment in uncomplicated UTI 1
• Routine follow-up cultures in asymptomatic patients add unnecessary cost without clinical benefit 2

When Repeat Testing IS Indicated

You should obtain repeat urine culture (not just urinalysis) in these specific circumstances:

• Symptoms that do not resolve by the end of treatment (typically 7-14 days) 1
• Symptoms that initially resolve but recur within 2 weeks after completing antibiotics 1
• Symptoms persisting beyond 7 days of initiating antimicrobial therapy 1

Clinical Decision Algorithm

For patients with persistent or recurrent symptoms:

• Obtain both urine culture AND antimicrobial susceptibility testing to guide further management 1
• Do not empirically prescribe a second antibiotic without obtaining culture results, as this promotes antimicrobial resistance 1
• Consider that rapid recurrence (particularly with the same organism) may indicate bacterial persistence requiring urologic evaluation 1

For patients with repeated infections from struvite stone-forming bacteria (e.g., Proteus mirabilis):

• Obtain imaging studies to rule out urinary calculi 1

Special Consideration for Hematuria

If the initial presentation included hematuria and you're evaluating for causes beyond infection:

• Repeat urinalysis 48 hours after cessation of potential benign causes (menstruation, vigorous exercise, sexual activity, trauma) 3
• If hematuria was associated with UTI, repeat urinalysis 6 weeks after treatment to ensure resolution 3
• Persistent hematuria after infection treatment warrants complete urologic evaluation 3

Common Pitfalls to Avoid

• Treating asymptomatic bacteriuria identified on routine post-treatment cultures—this represents colonization, not infection, and does not require treatment 1
• Failing to obtain culture when symptoms persist or recur early—this leads to inappropriate empiric treatment and missed opportunities to identify resistant organisms 1
• Not recognizing that microbiological clearance is not the treatment goal—clinical symptom resolution is the primary endpoint 1
• Ordering "test of cure" cultures in asymptomatic patients—this outdated practice increases healthcare costs and can lead to unnecessary antibiotic exposure 1