American Board of Family Medicine (ABFM) Practice Exam

What should be done when a patient presents with acute cystitis symptoms and no other alarming features?

1. Refer for urology evaluation

2. Start empirical antibiotic therapy

3. Conduct a battery of imaging studies

4. Order a comprehensive metabolic panel

The correct answer is: Start empirical antibiotic therapy

When a patient presents with symptoms of acute cystitis, such as dysuria, frequency, urgency, and suprapubic discomfort, and there are no alarming features (such as fever, flank pain, or signs of systemic infection), the best approach is to start empirical antibiotic therapy. Acute cystitis is generally a straightforward diagnosis, often based on clinical presentation alone, particularly in the absence of any concerning signs that would necessitate further investigation. In uncomplicated cases, empirical treatment is appropriate because the majority of urinary tract infections (UTIs) in otherwise healthy individuals are caused by common pathogens, like Escherichia coli. Administering empirical antibiotics enables prompt relief of symptoms and reduces the risk of complications, such as progression to pyelonephritis. Typical antibiotics prescribed might include nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, depending on local resistance patterns and patient allergies. The other approaches mentioned are typically not warranted in straightforward cases of acute cystitis. Referring for urology evaluation or ordering extensive imaging studies might be necessary if there were significant risk factors or recurrent infections, but in this context, they are excessive. Likewise, ordering a comprehensive metabolic panel does not aid in