Can I give sambong (Blumea balsamifera) to a 44‑year‑old woman with no chronic illnesses, occasional mechanical back pain, and mild pyuria (6–8 white blood cells per high‑power field)?

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Last updated: February 27, 2026 • View editorial policy

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Can Sambong Be Used in This Patient?

No, sambong should not be used in this 44-year-old woman with occasional back pain and mild pyuria (6-8 WBC/HPF), because she has no documented urinary tract infection and the pyuria level falls below the diagnostic threshold of ≥10 WBC/HPF required to diagnose a UTI. 1

Why Sambong Is Not Indicated

Pyuria Does Not Meet Diagnostic Criteria

  • The diagnostic threshold for clinically significant pyuria is ≥10 white blood cells per high-power field (WBC/HPF) or a positive leukocyte-esterase test; this patient's finding of 6-8 WBC/HPF is below that threshold and does not indicate infection. 1
  • Pyuria alone—even when it exceeds 10 WBC/HPF—has a low positive predictive value (approximately 43-56%) for actual urinary tract infection and must be accompanied by acute urinary symptoms (dysuria, frequency, urgency, fever >38.3°C, or gross hematuria) to justify treatment. 1
  • The absence of specific urinary symptoms in this patient means that even if pyuria were present at diagnostic levels, it would represent asymptomatic bacteriuria, which should not be treated. 2, 1

Occasional Back Pain Is Not a Urinary Symptom

  • Mechanical back pain without fever, costovertebral angle tenderness, dysuria, frequency, urgency, or hematuria does not constitute a urinary tract infection symptom and should not trigger UTI evaluation or treatment. 2, 1
  • Non-specific symptoms such as back pain, fatigue, or functional changes in the absence of acute urinary symptoms do not justify antimicrobial therapy or herbal diuretic use for presumed UTI. 2, 1

Sambong's Traditional Use and Lack of Evidence

  • Sambong (Blumea balsamifera) is traditionally used in Southeast Asian folk medicine as a diuretic and for kidney stones, but these ethnopharmacological applications have not been validated by rigorous clinical trials for urinary tract infections or asymptomatic pyuria. 3, 4
  • The plant contains bioactive compounds including borneol, β-caryophyllene, camphor, flavonoids, and quercetin, which demonstrate antioxidant, antimicrobial, and anti-inflammatory properties in vitro, but there is no published evidence supporting its efficacy or safety for treating urinary conditions in humans. 3, 5, 6, 4
  • Although sambong extracts show antibacterial activity against Staphylococcus aureus in laboratory studies, there are no data on its effectiveness against common uropathogens such as Escherichia coli, and no clinical trials have established appropriate dosing, safety profiles, or drug interactions. 6, 4

What Should Be Done Instead

Clinical Assessment

  • Do not order urinalysis, urine culture, or initiate any treatment (herbal or pharmaceutical) in the absence of acute urinary symptoms; testing asymptomatic individuals leads to detection of asymptomatic bacteriuria and subsequent inappropriate treatment. 2, 1
  • Evaluate the back pain as a separate musculoskeletal issue; consider mechanical causes, postural factors, or degenerative changes rather than attributing it to a urinary source. 1

Patient Education

  • Advise the patient to seek care only if she develops specific urinary symptoms such as dysuria, urinary frequency or urgency, suprapubic pain, fever >38.3°C, or gross hematuria. 1
  • Explain that mild pyuria (6-8 WBC/HPF) without symptoms does not indicate infection and does not require treatment, as 15-50% of women may have asymptomatic bacteriuria with low-level pyuria. 2, 1

When to Reconsider Evaluation

  • If acute urinary symptoms develop, obtain a properly collected midstream clean-catch urine specimen for urinalysis and culture before starting any therapy. 1
  • Confirm pyuria (≥10 WBC/HPF or positive leukocyte-esterase) and the presence of acute symptoms before considering antimicrobial therapy. 1

Common Pitfalls to Avoid

  • Do not treat based on pyuria alone without accompanying urinary symptoms; this leads to unnecessary antibiotic or herbal remedy exposure, promotes antimicrobial resistance, and provides no clinical benefit. 2, 1
  • Do not assume that herbal diuretics like sambong are harmless; they may have unrecognized drug interactions, adverse effects, or contraindications, and their use in the absence of a clear indication exposes the patient to unnecessary risk. 3, 4
  • Do not attribute non-specific symptoms (back pain, fatigue) to urinary tract issues without documented infection; this practice leads to overdiagnosis and overtreatment of asymptomatic bacteriuria. 2, 1

References

1
Guideline

Urinary Tract Infection Diagnosis and Evaluation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

Blumea balsamifera--a phytochemical and pharmacological review.

Molecules (Basel, Switzerland), 2014

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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