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Published in: BMC Primary Care 1/2013

Open Access 01-12-2013 | Research article

Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study

Authors: Bart J Knottnerus, Suzanne E Geerlings, Eric P Moll van Charante, Gerben ter Riet

Published in: BMC Primary Care | Issue 1/2013

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Abstract

Background

Women presenting with symptoms of acute uncomplicated urinary tract infection (UTI) are often prescribed antibiotics. However, in 25 to 50% of symptomatic women not taking antibiotics, symptoms recover spontaneously within one week. It is not known how many women are prepared to delay antibiotic treatment. We investigated how many women presenting with UTI symptoms were willing to delay antibiotic treatment when asked by their general practitioner (GP).

Methods

From 18 April 2006 until 8 October 2008, in a prospective cohort study, patients were recruited in 20 GP practices in and around Amsterdam, the Netherlands. Healthy, non-pregnant women who contacted their GP with painful and/or frequent micturition for no longer than seven days registered their symptoms and collected urine for urinalysis and culture. GPs were requested to ask all patients if they were willing to delay antibiotic treatment, without knowing the result of the culture at that moment. After seven days, patients reported whether their symptoms had improved and whether they had used any antibiotics.

Results

Of 176 women, 137 were asked by their GP to delay antibiotic treatment, of whom 37% (51/137) were willing to delay. After one week, 55% (28/51) of delaying women had not used antibiotics, of whom 71% (20/28) reported clinical improvement or cure. None of the participating women developed pyelonephritis.

Conclusions

More than a third of women with UTI symptoms are willing to delay antibiotic treatment when asked by their GP. The majority of delaying women report spontaneous symptom improvement after one week.
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Literature
1.
go back to reference Clayson D, Wild D, Doll H, Keating K, Gondek K: Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire. BJU Int. 2005, 96: 350-359. 10.1111/j.1464-410X.2005.05630.x.CrossRefPubMed Clayson D, Wild D, Doll H, Keating K, Gondek K: Validation of a patient-administered questionnaire to measure the severity and bothersomeness of lower urinary tract symptoms in uncomplicated urinary tract infection (UTI): the UTI Symptom Assessment questionnaire. BJU Int. 2005, 96: 350-359. 10.1111/j.1464-410X.2005.05630.x.CrossRefPubMed
2.
go back to reference Colgan R, Keating K, Dougouih M: Survey of symptom burden in women with uncomplicated urinary tract infections. Clin Drug Investig. 2004, 24: 55-60. 10.2165/00044011-200424010-00007.CrossRefPubMed Colgan R, Keating K, Dougouih M: Survey of symptom burden in women with uncomplicated urinary tract infections. Clin Drug Investig. 2004, 24: 55-60. 10.2165/00044011-200424010-00007.CrossRefPubMed
3.
go back to reference Ellis AK, Verma S: Quality of life in women with urinary tract infections: is benign disease a misnomer?. J Am Board Fam Pract. 2000, 13: 392-397.CrossRefPubMed Ellis AK, Verma S: Quality of life in women with urinary tract infections: is benign disease a misnomer?. J Am Board Fam Pract. 2000, 13: 392-397.CrossRefPubMed
4.
go back to reference Malterud K, Baerheim A: Peeing barbed wire. Symptom experiences in women with lower urinary tract infection. Scand J Prim Health Care. 1999, 17: 49-53. 10.1080/028134399750002908.CrossRefPubMed Malterud K, Baerheim A: Peeing barbed wire. Symptom experiences in women with lower urinary tract infection. Scand J Prim Health Care. 1999, 17: 49-53. 10.1080/028134399750002908.CrossRefPubMed
5.
go back to reference Barry HC, Ebell MH, Hickner J: Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Pract. 1997, 44: 49-60.PubMed Barry HC, Ebell MH, Hickner J: Evaluation of suspected urinary tract infection in ambulatory women: a cost-utility analysis of office-based strategies. J Fam Pract. 1997, 44: 49-60.PubMed
6.
go back to reference Fenwick EA, Briggs AH, Hawke CI: Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract. 2000, 50: 635-639.PubMedPubMedCentral Fenwick EA, Briggs AH, Hawke CI: Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract. 2000, 50: 635-639.PubMedPubMedCentral
7.
go back to reference Chomarat M: Resistance of bacteria in urinary tract infections. Int J Antimicrob Agents. 2000, 16: 483-487. 10.1016/S0924-8579(00)00281-8.CrossRefPubMed Chomarat M: Resistance of bacteria in urinary tract infections. Int J Antimicrob Agents. 2000, 16: 483-487. 10.1016/S0924-8579(00)00281-8.CrossRefPubMed
8.
go back to reference Gupta K, Scholes D, Stamm WE: Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA. 1999, 281: 736-738. 10.1001/jama.281.8.736.CrossRefPubMed Gupta K, Scholes D, Stamm WE: Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA. 1999, 281: 736-738. 10.1001/jama.281.8.736.CrossRefPubMed
9.
go back to reference Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE: Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis. 2004, 39: 75-80. 10.1086/422145.CrossRefPubMed Hooton TM, Besser R, Foxman B, Fritsche TR, Nicolle LE: Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis. 2004, 39: 75-80. 10.1086/422145.CrossRefPubMed
10.
go back to reference Kahlmeter G: An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003, 51: 69-76. 10.1093/jac/dkg028.CrossRefPubMed Kahlmeter G: An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. J Antimicrob Chemother. 2003, 51: 69-76. 10.1093/jac/dkg028.CrossRefPubMed
11.
go back to reference Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM: Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002, 52: 729-734.PubMedPubMedCentral Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM: Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002, 52: 729-734.PubMedPubMedCentral
12.
go back to reference Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ: Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007, 25: 49-57. 10.1080/02813430601183074.CrossRefPubMedPubMedCentral Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ: Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care. 2007, 25: 49-57. 10.1080/02813430601183074.CrossRefPubMedPubMedCentral
13.
go back to reference Richards D, Toop L, Chambers S, Fletcher L: Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial. BMJ. 2005, 331: 143-10.1136/bmj.38496.452581.8F.CrossRefPubMedPubMedCentral Richards D, Toop L, Chambers S, Fletcher L: Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial. BMJ. 2005, 331: 143-10.1136/bmj.38496.452581.8F.CrossRefPubMedPubMedCentral
14.
go back to reference Leydon GM, Turner S, Smith H, Little P: Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ. 2010, 340: c279-10.1136/bmj.c279.CrossRefPubMedPubMedCentral Leydon GM, Turner S, Smith H, Little P: Women’s views about management and cause of urinary tract infection: qualitative interview study. BMJ. 2010, 340: c279-10.1136/bmj.c279.CrossRefPubMedPubMedCentral
15.
go back to reference Knottnerus BJ, Bindels PJ, Geerlings SE, van Charante EP Moll, ter Riet G: Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections. BMC Fam Pract. 2008, 9: 64-10.1186/1471-2296-9-64.CrossRefPubMedPubMedCentral Knottnerus BJ, Bindels PJ, Geerlings SE, van Charante EP Moll, ter Riet G: Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections. BMC Fam Pract. 2008, 9: 64-10.1186/1471-2296-9-64.CrossRefPubMedPubMedCentral
16.
go back to reference Van Haaren KAM, Visser HS, Van Vliet S, Timmermans AE, Yadava R, Geerlings SE, Ter Riet G, Van Pinxteren B: NHG-Standaard Urineweginfecties (tweede herziening). Huisarts Wet. 2005, 8: 341-352. Van Haaren KAM, Visser HS, Van Vliet S, Timmermans AE, Yadava R, Geerlings SE, Ter Riet G, Van Pinxteren B: NHG-Standaard Urineweginfecties (tweede herziening). Huisarts Wet. 2005, 8: 341-352.
17.
go back to reference Baerheim A, Laerum E: Home-voided urine specimens in women. Diagnostic agreement with clean-catch midstream specimens. Scand J Prim Health Care. 1990, 8: 207-211. 10.3109/02813439008994960.CrossRefPubMed Baerheim A, Laerum E: Home-voided urine specimens in women. Diagnostic agreement with clean-catch midstream specimens. Scand J Prim Health Care. 1990, 8: 207-211. 10.3109/02813439008994960.CrossRefPubMed
18.
go back to reference Leisure MK, Dudley SM, Donowitz LG: Does a clean-catch urine sample reduce bacterial contamination?. N Engl J Med. 1993, 328: 289-290. 10.1056/NEJM199301283280420.CrossRefPubMed Leisure MK, Dudley SM, Donowitz LG: Does a clean-catch urine sample reduce bacterial contamination?. N Engl J Med. 1993, 328: 289-290. 10.1056/NEJM199301283280420.CrossRefPubMed
19.
go back to reference Lifshitz E, Kramer L: Outpatient urine culture: does collection technique matter?. Arch Intern Med. 2000, 160: 2537-2540. 10.1001/archinte.160.16.2537.CrossRefPubMed Lifshitz E, Kramer L: Outpatient urine culture: does collection technique matter?. Arch Intern Med. 2000, 160: 2537-2540. 10.1001/archinte.160.16.2537.CrossRefPubMed
20.
go back to reference European Confederation of Laboratory Medicine: Scand J Clin Lab Invest. 2000, 231: 1-96. European Confederation of Laboratory Medicine: Scand J Clin Lab Invest. 2000, 231: 1-96.
21.
go back to reference Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N: Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998, 317: 637-642. 10.1136/bmj.317.7159.637.CrossRefPubMedPubMedCentral Butler CC, Rollnick S, Pill R, Maggs-Rapport F, Stott N: Understanding the culture of prescribing: qualitative study of general practitioners’ and patients’ perceptions of antibiotics for sore throats. BMJ. 1998, 317: 637-642. 10.1136/bmj.317.7159.637.CrossRefPubMedPubMedCentral
22.
go back to reference Chan CS: What do patients expect from consultations for upper respiratory tract infections?. Fam Pract. 1996, 13: 229-235. 10.1093/fampra/13.3.229.CrossRefPubMed Chan CS: What do patients expect from consultations for upper respiratory tract infections?. Fam Pract. 1996, 13: 229-235. 10.1093/fampra/13.3.229.CrossRefPubMed
23.
go back to reference Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, Smith H, Hawke C, Leydon G, Arscott A: Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010, 340: c199-10.1136/bmj.c199.CrossRefPubMedPubMedCentral Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, Smith H, Hawke C, Leydon G, Arscott A: Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010, 340: c199-10.1136/bmj.c199.CrossRefPubMedPubMedCentral
24.
go back to reference Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E: Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection?–results of a randomized controlled pilot trial. BMC Med. 2010, 8: 30-10.1186/1741-7015-8-30.CrossRefPubMedPubMedCentral Bleidorn J, Gagyor I, Kochen MM, Wegscheider K, Hummers-Pradier E: Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection?–results of a randomized controlled pilot trial. BMC Med. 2010, 8: 30-10.1186/1741-7015-8-30.CrossRefPubMedPubMedCentral
25.
go back to reference Gagyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J: Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis. 2012, 12: 146-10.1186/1471-2334-12-146.CrossRefPubMedPubMedCentral Gagyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J: Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis. 2012, 12: 146-10.1186/1471-2334-12-146.CrossRefPubMedPubMedCentral
Metadata
Title
Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study
Authors
Bart J Knottnerus
Suzanne E Geerlings
Eric P Moll van Charante
Gerben ter Riet
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2013
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-14-71

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