Evid Based Nurs 9:17 doi:10.1136/ebn.9.1.17
  • Treatment

Trimethoprim reduced dysuria in women with symptoms of urinary tract infection but negative urine dipstick test results

 Q Are antibiotics effective for treatment of women with symptoms of urinary tract infection (UTI) but negative results on urine dipstick testing?



randomised, placebo controlled trial.




blinded (patients, healthcare providers, data collectors, and {outcome assessors}*).

GraphicFollow up period:

3 and 7 days.


general practices in Christchurch, New Zealand.


66 women who were 16–50 years of age and had a history of dysuria and frequency and a negative dipstick test for both leucocytes and nitrates. (7 women were excluded after randomisation because they did not meet the age criteria.) Exclusion criteria were pregnancy, complicated UTI including symptoms of pyelonephritis, known allergy to trimethoprim, proven UTI, or treatment for presumed UTI in the past month.


26 women were allocated to trimethoprim, 300 mg, for 3 days, and 33 were allocated to placebo.


main outcomes were resolution of dysuria at 3 and 7 days and median time to resolution of dysuria (based on symptom diaries and/or a structured telephone questionnaire); secondary outcomes were resolution of other symptoms.

GraphicPatient follow up:

59 women (89%) completed the structured telephone questionnaire at 7 days (mean age 36 y).


Among women who reported dysuria on day 1 (n = 48), fewer women in the trimethoprim group than in the placebo group still had dysuria on day 3 and day 7 (table). Women in the trimethoprim group had a shorter median time to resolution of dysuria (3 v 5 d, p = 0.002). Among women reporting feverishness or shivers at baseline (n = 22), fewer women in the trimethoprim group had these symptoms at 3 days, but the groups did not differ at 7 days (table); women in the trimethoprim group had a shorter median time to resolution of feverishness or shivers (2 v 6 d, p = 0.02). Among women reporting baseline symptoms of frequency (n = 55), blood in urine (n = 8), itching (n = 22), abdominal pain (n = 47), or low back pain (n = 31), the trimethoprim and placebo groups did not differ for continued presence of the specific symptom at 3 or 7 days or for median time to resolution of symptoms.

Trimethoprim v placebo in women with symptoms of urinary tract infection but negative urine dipstick results*


In women with symptoms of urinary tract infection but negative urine dipstick results for both nitrites and leucocytes, trimethoprim for 3 days reduced dysuria at 7 days.

A modified version of this abstract also appears in ACP Journal Club.


  1. M Kay Libbus, RN, DrPH
  1. University of Missouri, Sinclair School of Nursing
 Columbia, Missouri, USA

      A test that can reliably differentiate between ill and well patients is particularly helpful in high prevalence disorders such as uncomplicated UTIs in women of childbearing age. Screening tests such as rapid strep tests have made it possible to balance the prudent use of primary healthcare resources, patient resources, and sound healthcare practice. The ideal screening test would give clinicians instant identification and suggest appropriate intervention.

      In the study by Richards et al, the women who reported dysuria and frequency, common UTI symptoms, also screened negative for UTI by standard urine dipstick. Women empirically treated with antibiotics had significantly reduced symptoms at both 3 and 7 days. It is tempting to adopt this set of signs and symptoms as sufficient screening to guide practice. The blinded study was well designed but has limited generalisability because of the small sample size (59 women over a 2 y period). Although the authors estimated that ⩾300 women should have been available during this period, only 20% of eligible women participated. Probability sampling was not used, and participant recruitment appeared to depend on personal contact by 30 individual clinicians. Alternative hypotheses for the findings cannot be ruled out. It is possible that patients who were actively recruited by clinicians were infected with uropathogens that responded well to the study drug. Furthermore, although no covariates were associated with findings, participants may differ from the total population in important ways.

      The empirical use of antibiotic therapy also requires consideration of the potential development of resistant micro-organisms. Urine “culture and sensitivity” remains the standard for clinical management of UTIs in women, especially because there are comfort measures that can be used to allay patient symptoms until accurate diagnosis is acquired.


      • * Information provided by author.

      • For correspondence: Dr D Richards, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand. derelie.richards{at}

      • Source of funding: Health Research Council of New Zealand.

      Free Sample

      This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EBN.
      View free sample issue >>

      EBN Journal Chat

      The EBN Journal Chat offers readers the opportunity to participate in discussion about research articles and commentaries from Evidence Based Nursing (EBN).

      How to participate >>

      Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

      Navigate This Article