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Patient-Initiated Treatment of Recurrent Urinary Tract Infection in Women
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What is the problem and what is known about it so far?
Urinary tract infections (UTIs or “bladder infections”) are common in women. UTIs can be recurrent, meaning that they happen again, even after appropriate treatment. Some doctors give women with recurrent UTIs regular low doses of antibiotics to prevent future infections, but this involves the cost and inconvenience of taking medicine for a condition that might or might not occur again. UTI symptoms include frequent and painful urination, so women usually can easily tell when they have a UTI. Patient-initiated treatment is another way to handle recurrent UTI. In this approach, doctors give patients a standing prescription for antibiotics to take only when symptoms occur. Patient-initiated treatment avoids the need to see a doctor and the inconvenience of preventive antibiotics.
Why did the researchers do this particular study?
To see whether patient-initiated treatment of recurrent UTI in women is an effective treatment strategy and is acceptable to patients.
Who was studied?
172 women with a history of two or more UTIs within the past year. The women were 23 years old on average, were not pregnant, and were healthy.
How was the study done?
The researchers gave each woman a kit for obtaining urine specimens and taught her how to use it. Each woman also receievd a 3-day supply of antibiotics to take if they developed UTI symptoms; they were instructed to take the antibiotics after collecting a urine specimen. The researchers tested the urine specimen to see whether the woman actually had an infection and collected information from the women about whether and when the symptoms resolved. Urine specimens were tested again after treatment. If symptoms continued despite treatment, women were sent to a doctor for evaluation.
What did the researchers find?
Of the 172 women in the study, 88 reported 172 episodes of symptoms (some women had more than one episode during the study). Of the 172 episodes, the urine specimen confirmed a definite infection in 84% and a probable infection in 11%. Of the women who initiated treatment, 92% reported that symptoms went away, and 96% of the follow-up urine tests showed cure of the infection. No serious complications occurred, and the women were generally highly satisfied with self-treatment.
What were the limitations of the study?
Patient-initiated treatment might not work or be safe in older, pregnant, or sick women or in men. The study did not include a comparison group who received preventive antibiotics or saw the doctor when symptoms occurred, so it does not tell us whether patient-initiated treatment is more effective or safer than these other strategies.
What are the implications of the study?
Young, nonpregnant, healthy women can accurately tell when they have a UTI. Patient-initiated treatment seems to be an effective and safe way to treat recurrent UTIs.
Article and Author Information
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The summary below is from the full report titled “Patient-Initiated Treatment of Uncomplicated Recurrent Urinary Tract Infections in Young Women.” It is in the 3 July 2001 issue of Annals of Internal Medicine (volume 135, pages 9-16). The authors are K Gupta, TM Hooton, PL Roberts, and WE Stamm.
- Copyright ©2004 by the American College of Physicians
