Patient-Initiated Treatment of Uncomplicated Recurrent Urinary Tract Infections in Young Women

3 July 2001 | Volume 135 Issue 1 | Pages 9-16

Background: Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience.

Objective: To determine the safety and feasibility of patient-initiated treatment of recurrent UTIs.

Design: Uncontrolled, prospective clinical trial.

Setting: University-based primary health care clinic.

Participants: Women at least 18 years of age with a history of recurrent UTIs and no recent pregnancy, hypertension, diabetes, or renal disease.

Intervention: After self-diagnosing UTI on the basis of symptoms, participating women initiated therapy with ofloxacin or levofloxacin.

Measurements: Accuracy of self-diagnosis determined by evidence of a definite (culture-positive) or probable (sterile pyuria and no alternative diagnosis) UTI on pretherapy urinalysis and culture. Women with a self-diagnosis of UTI that was not microbiologically confirmed were evaluated for alternative diagnoses. Post-therapy interviews and urine cultures were used to assess clinical and microbiological cure rates, adverse events, and patient satisfaction.

Results: 88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogen in 144 cases (84%), sterile pyuria in 19 cases (11%), and no pyuria or bacteriuria in 9 cases (5%). Clinical and microbiological cures occurred in 92% and 96%, respectively, of culture-confirmed episodes. No serious adverse events occurred.

Conclusion: Adherent women can accurately self-diagnose and self-treat recurrent UTIs.

Author and Article Information

From the University of Washington, Seattle, Washington.

Presented in part at the 1998 and 2000 annual meetings of the Infectious Diseases Society of America (Denver, Colorado, and New Orleans, Louisiana) and at the Sixth International Symposium on New Quinolones, Denver, Colorado, 1998.

Disclaimer: Dr. Gupta has served as a consultant for and received research support and speaking honoraria from Procter & Gamble and Bayer Pharmaceutical. Dr. Hooton has received research support and speaking honoraria from Ortho-McNeil Pharmaceutical, Procter & Gamble, Bristol-Meyers Squibb, Pfizer, and Bayer Pharmaceutical. Dr. Stamm has served as a consultant for and received research support and honoraria from Procter & Gamble, Ortho-McNeil Pharmaceutical, and Bayer Pharmaceutical.

Acknowledgments: The authors thank Mary B. Watts, MD, and the staff at Hall Health Primary Care Center for assistance with patient enrollment; Carol Winter, ARNP, and Natalie DeShaw, Research Study Coordinator, for patient enrollment and follow-up and database management; and Cheryl Wobbe, Cindy Fennell, Sheila Manuguid, Shuli Denton, and Marsha Cox for careful microbiological studies.

Grant Support: In part by the National Institutes of Health (DK 47549 and DK 53369) and by Ortho-McNeil Pharmaceutical, Raritan, New Jersey.

Requests for Single Reprints: Kalpana Gupta, MD, MPH, Department of Medicine/Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Box 356523, University of Washington, Seattle, WA 98195; e-mail, kalg{at}u.washington.edu.

Current Author Addresses: Drs. Gupta, Hooton, and Stamm and Ms. Roberts: Department of Medicine/Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Box 356523, University of Washington, Seattle, WA 98195.

Author Contributions: Conception and design: K. Gupta, T.M. Hooton, W.E. Stamm.

Analysis and interpretation of the data: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Drafting of the article: K. Gupta, T.M. Hooton.

Critical revision of the article for important intellectual content: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Final approval of the article: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Statistical expertise: P.L. Roberts.

Obtaining of funding: T.M. Hooton, W.E. Stamm.

Administrative, technical, or logistic support: K. Gupta, T.M. Hooton, W.E. Stamm.

Collection and assembly of data: K. Gupta, P.L. Roberts.