On the face of it, urinary tract infection seems to be a straightforward clinical presentation with an equally straightforward therapeutic response. Unlike other symptom constellations for which antibiotics are prescribed in primary care, bacterial infection is more likely to be present than not and empirical treatment is cost effective.1 2 The problem with empirical treatment is that 10% of the healthy adult female population would receive antibiotics each year. The use of antibiotics to this extent in the population has implications for antibiotic resistance. Three linked studies assess the management of urinary tract infection in primary care,3 4 5 and one assesses the cost effectiveness of different management strategies (doi:10.1136/bmj.c346).6

Research in this area focuses on strategies for reducing the use of antibiotics. This highlights the tension between maximising the benefit for individuals and minimising antibiotic resistance at a population level. In studies of treatment, diagnosis and cure were traditionally defined in bacteriological rather than symptomatic terms, on the assumption that people with detectable infection would benefit whereas those without infection would not. However, evidence indicates that many women with bacteriological urinary tract infection will recover without antibiotics. …