Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey

Butler, Christopher Collett; Hawking, Meredith K D; Quigley, Anna; McNulty, C.

doi:10.3399/bjgp15x686965

Cited by 106 publications

(144 citation statements)

References 22 publications

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“…Fast 40 % der Frauen erkranken mindestens einmal im Leben an einer symptomatischen Harnwegsinfektion. Die Prävalenz nimmt mit dem Alter zu [2,3,10].…”

Section: Hintergrundunclassified

Antimikrobielle Therapie der Harnwegsinfektionen

2019

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ZUSAMMENFASSUNGHarnwegsinfektionen gehören zu den häufigsten Infektionen im ambulanten Bereich und stellen auch die häufigsten nosokomialen Infektionen dar. Die typischen Symptome sind Schmerzen beim Wasserlassen (Algurie), häufiges Wasserlassen (Pollakisurie), imperativer Harndrang (Strangurie) und ggf. Hämaturie. Es wird eine unkomplizierte von einer komplizierten Harnwegsinfektion unterschieden, die sich im Keimspektrum und dadurch in der therapeutischen Strategie unterscheiden. Harnwegsinfekte bei Männern sollten in der Regel als komplizierte Infektionen eingeschätzt werden, da die Prostata mitbetroffen sein kann. Als Diagnostik stehen die Anamnese, die körperliche Untersuchung, die Urinuntersuchung durch Schnellstreifentest, die Mikroskopie und die Urinkultur zur Verfügung. Der häufigste Erreger von unkomplizierten Harnwegsinfektionen ist Escherichia coli, gefolgt mit Abstand von Staphylococcus saprophyticus, Proteus mirabilis und Klebsiella pneumoniae. Bei komplizierten Harnwegsinfektionen sollte der vorherige Erregernachweis berücksichtigt werden, wenn dieser bekannt ist. Bei einer akuten unkomplizierten Harnwegsinfektion ist eine orale kurzzeitige antimikrobielle Therapie empfohlen, um die klinischen Symptome rasch zu beenden. Die Dauer der Therapie orientiert sich am klinischen Verlauf.

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“…Fast 40 % der Frauen erkranken mindestens einmal im Leben an einer symptomatischen Harnwegsinfektion. Die Prävalenz nimmt mit dem Alter zu [2,3,10].…”

Section: Hintergrundunclassified

Antimikrobielle Therapie der Harnwegsinfektionen

2019

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“…Uncomplicated urinary tract infections (UTIs) are common in women and are usually managed in primary care [1,2]. Primary care physicians mainly prescribe antibiotics [3,4], as recommended by most guidelines [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…Symptomatic treatment with nonsteroidal anti-in ammatory drugs (NSAIDs) is also recommended by several guidelines for women with mild to moderate symptoms [6][7][8]. However, many women seem to prefer not to take antibiotics and to handle UTI symptoms with NSAIDs and other measures or remedies, presumably from their knowledge of potential harms of antibiotics and especially when they were encouraged by their physicians to delay antibiotic treatment [1,9,10]. In Germany, women who forego antibiotics do not have directs costs, since consultations and most of the drugs costs are covered by the health insurance [11].…”

Section: Introductionmentioning

confidence: 99%

Management of urinary tract infections what do doctors recommend and patients do? An observational study in German primary care

Gágyor¹,

Strube-Plaschke

Rentzsch

et al. 2020

Preprint

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Background Uncomplicated urinary tract infections (UTIs) in women are usually managed in primary care with antibiotics. However, many women seem to prefer to handle UTI symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) and other remedies. The aim of this study was to compare UTI management as recommended by physicians with the patients’ management at home.Methods This prospective cohort study in German primary care is based on clinical data from local practices and patient questionnaires. Participating women completed a baseline data sheet in the practice; their urine sample was tested by a dipstick in the practice and cultured by a laboratory. The women reported treatment and symptom-related impairment on an eight-item symptom questionnaire daily for 7 days. Using growth curve models, we analysed the influence of time on the total severity score to examine how symptoms changed across days. We then examined whether symptom severity and symptom course differed between patients who took antibiotics or NSAIDs.Results A total of 120 women (mean age of 43.3 ± 16.6 years) were enrolled. The urine dipstick was positive for leucocytes in 92%, erythrocytes in 87%, and nitrites in 23%. Physicians prescribed antibiotics for 102 (87%) women and recommended NSAIDs in 14 cases. According to the women’s reports, only 60% (72/120) took antibiotics, while the remainder took NSAIDs and other remedies. Symptoms declined from day 0 to day 6, irrespective of whether women decided to take an antibiotic, NSAIDs, none or both, as confirmed by a significant curvilinear time effect (B = 0.06, SE = 0.005, p < .001). The symptom course, however, was moderated by taking antibiotics so that the change in symptom severity was somewhat more pronounced in women taking antibiotics (B = 0.06) than in the remainder (B = 0.04).Conclusion A substantial proportion of women did not follow their physicians’ treatment recommendations, and many used NSAIDs. All women had a good chance of recovery irrespective of whether they decided to take antibiotics. A sensitive listening to patient preferences in the consultation may encourage physicians to recommend and prescribe symptomatic treatment with NSAID more often than antibiotic medicines.

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“…Acute cystitis affects several facets of a patient's life: social and intimate relationships, self-esteem, and the ability to work. Depending on the situation, the impact can vary from being slight to very signi cant [3] [4].…”

Section: Introductionmentioning

confidence: 99%

“…Physicians overestimate patients' desire to take an antibiotic [16]. Patients do not always take the prescribed treatment [4]. Several authors have suggested a shared decision-making approach in uUTI [18] [19].…”

Section: Introductionmentioning

confidence: 99%

Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

Vincent

Frachon

BUFFETEAU

et al. 2020

Preprint

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Background Uncomplicated urinary tract infection (uUTI) is a frequent reason for consulting a general practitioner. The risk of pyelonephritis is low. Antibiotics are prescribed empirically for symptomatic purposes. It can induce undesirable effects and resistance. Patients sometimes wish to avoid taking antibiotics. Some European countries recommend discussing a delayed prescription with the patient and developing a shared decision. The aim of our study is to develop a patient decision aid (PtDA) that can be used in primary care to make a shared decision about whether to treat uncomplicated urinary tract infection with antibiotics or not. Methods We followed the steps recommended by the International Patient Decision Aids Standards, which include a design phase (focus groups, bibliography) and an alpha-testing phase. A steering group developed a draft and then final version of a prototype PtDA. Results The information included in the PtDA is the definition of uUTI, information on the options, their benefits, risks and consequences. The patient's values and preferences to be considered in the decision are related to the discomfort felt, the impact on daily life, the representations of the antibiotic, the position relative to the risk of adverse effect. Conclusions Our results confirm a need for decision making and the equilibrium in this situation. We lacked advice from outside physicians in the study. This PtDA needs to be validated in a beta-testing phase. It must then be tested in a clinical study comparing its use with the systematic prescription approach.

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Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey

Abstract: Background

Cited by 106 publications

References 22 publications

Antimikrobielle Therapie der Harnwegsinfektionen

Antimikrobielle Therapie der Harnwegsinfektionen

Management of urinary tract infections what do doctors recommend and patients do? An observational study in German primary care

Construction of a patient decision aid for the treatment of uncomplicated urinary tract infection in primary care

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