Question: if a repeat presenter with UTI symptoms continually doesn't grow any isolates on a MSSU, is empirical antibiotic treatment still appropriate each time or would it be reasonable to try the non antibiotic approaches already highlighted in questions and only treat subsequently if something is grown from an MSSU?

Cliodna McNulty answered on 11 Nov 2016:

I think it depends on the symptoms. If the patient has vaginal discharge, this makes UTI less likely. Check the patient doesn’t have risk factors for STIs, as chlamydia is a possibility. Is the patient post menopausal? Could vaginal atrophy and change of vaginal flora be contributing to symptoms? It would also be worth speaking to the lab to see what the bacterial count is. With symptoms, a CFU down to 10×3 /ml of a single organism especially E.coli would be considered significant.
Also if symptoms are mild it may not be appropriate to give antibiotics, you could consider a non steroidal anti-inflammatory drug.