Approach

History

Uncomplicated cases can be diagnosed and treated on the basis of the history alone. Doing this over the telephone without a clinic visit has been shown to be safe and effective.[28] Typical symptoms include dysuria, urgency, and frequency. Patients should be screened for conditions that would qualify them as having complicated cystitis. Fever, chills, nausea, vomiting, abdominal pain, and flank pain can suggest possible pyelonephritis and further evaluation is mandatory. Vaginal pruritus or discharge may suggest vaginitis.

Complicated cases include patients with any of the following: male sex, pregnancy, indwelling urinary catheter, history of recurrent urinary tract infections (UTIs), structurally or functionally abnormal urinary bladder, recent instrumentation, history of infection with drug-resistant bacteria, failed course of treatment for uncomplicated cystitis, diabetes mellitus, or immunosuppressed state. These patients should always have their diagnosis confirmed with urinalysis and culture.

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