A urine dipstick is most useful in a woman with urinary symptoms when it is negative for both nitrites and leucocyte esterase, which makes a bacterial urinary tract infection less likely. Positive results need to be read with symptoms: asymptomatic bacteriuria is common in older adults and should not be treated by default.
So dip, interpret with the story, send a culture where the picture is unclear, complicated or recurrent, and avoid treating a positive dipstick in a patient with no urinary symptoms.
- Use a negative dipstick to make infection less likely when symptoms are mild.
- Interpret a positive result with symptoms; do not treat bacteriuria without them.
- Send a culture for recurrent, complicated or treatment-failure cases.
- Be cautious in older adults with confusion alone as the only symptom.
Why it matters
It keeps a quick bedside test from driving unnecessary antibiotics.
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