Antibiotic Stewardship in Urinary Tract Infections

Discontinuation of Empirical Antibiotics

When a patient has a negative urine culture, empirical antibiotics should be discontinued as there is no evidence of bacterial infection requiring treatment, according to the Clinical Microbiology and Infection guideline 1
The 2021 guideline for antibacterial therapy recommends stopping antibiotics when representative cultures show no bacterial pathogens after 48 hours of incubation, as stated by the Clinical Microbiology and Infection guideline 1
Discontinuing empirical antibiotics after 48 hours if cultures demonstrate no bacterial growth is recommended for hospitalized patients with suspected infection, as suggested by the Hepatology guideline 2
For patients with fever and neutropenia, discontinuing empirical antibiotics is recommended in patients who have negative blood cultures at 48 hours, have been afebrile for at least 24 hours, and have evidence of marrow recovery, according to the Journal of Clinical Oncology guideline 3
For low-risk patients with fever and neutropenia, consider discontinuation of empirical antibiotics at 72 hours with negative cultures and resolution of fever for 24+ hours, even without marrow recovery, as recommended by the Journal of Clinical Oncology guideline 3
Restrictive use of antibiotics is recommended for patients with COVID-19, and stopping antibiotics when cultures are negative after 48 hours of incubation is advised, as stated by the Clinical Microbiology and Infection guideline 1

Obtaining cultures before starting antibiotics is crucial, as even a single dose of antibiotics can cause cultures to be negative, according to the Hepatology guideline 2
Ensuring proper collection technique to minimize contamination and interpreting results in clinical context is essential to avoid misinterpreting contaminated specimens as infection 2
The practice of continuing antibiotics "just to be safe" contributes to antimicrobial resistance, and there is no evidence to support continuing antibiotics with negative cultures in clinically stable patients 1