Uncomplicated cystitis — RACGP Fellowship MCQ

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ModerateInfectious diseaseUncomplicated cystitisRACGP Fellowship

A 25‑year‑old woman presents with dysuria and urinary frequency for one day. She is not pregnant, has no flank pain, fever, vaginal symptoms or recurrent urinary infections. Urinalysis shows positive leukocytes and nitrites. What is the most appropriate management?

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Correct answer: B — Treat empirically for uncomplicated cystitis without routine urine culture

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · A = shown as D · B = shown as E

This presentation is consistent with uncomplicated acute cystitis in a healthy, non‑pregnant woman with classic symptoms and a positive dipstick (leukocytes and nitrites). Australian Prescriber guidance supports commencing empirical oral antibiotic treatment without awaiting culture in such cases, reserving microscopy, culture and susceptibility testing for men, pregnant women or recurrent/complicated infections. The RACGP likewise states that empirical antibiotics are justified with positive dipstick in symptomatic women. First‑line oral agents in Australia include trimethoprim or nitrofurantoin. Routine delay for culture (Option A), imaging (B), IV ceftriaxone (D) or urology referral (E) are unnecessary and inappropriate in uncomplicated cystitis.

Reference: Australian Prescriber (Jarvis et al., “Assessment and management of lower urinary tract infection in adults”, 2014) and RACGP (“Bacterial cystitis in women”, 2010); plus Therapeutic Guidelines (eTG) March 2025 update recommending nitrofurantoin as first‑line acute cystitis treatment. https://australianprescriber.tg.org.au/articles/assessment-and-management-of-lower-urinary-tract-infection-in-adults.html