Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

Mishra, Bharti; Srivastava, Shubhi; Singh, Kuldeep; Pandey, Anshuman; Agarwal, Jyotsna

doi:10.1111/j.1742-1241.2012.02906.x

Cited by 23 publications

(18 citation statements)

References 21 publications

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“…The combination of urgency, burning during micturition, and pyuria was found to be the best predictor of UTI with AUC of 78.48% and +LR 2.97. Pyuria in urinalysis and frequency of sexual intercourse more than 5 times per month in history were found to be significantly associated with positive urine culture [35]. The absence of pyuria was the best predictor for ruling out lower UTI even in symptomatic women (AUC 77.07%, -LR 0.1).…”

Section: Discussionmentioning

confidence: 76%

“…The diagnostic accuracy of urinary symptoms and their combinations for early diagnosis of lower UTIs was described in by Mishra et al [35]. Using the results of the urine culture (> 10 2 colony-forming units (CFU)/mL) as a reference for diagnosis, they have found that urgency, burning sensation during urination, and dysuria were the best predictor symptoms for lower UTI.…”

Section: Discussionmentioning

confidence: 99%

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Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

et al. 2018

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Background and Objectives: Acute uncomplicated cystitis (AC) is common among women. Acute onset of specific typical symptoms may serve as reliable criteria for developing a cost-effective strategy to make an accurate diagnosis of AC. We aimed to evaluate the diagnostic values of most common symptoms and signs of AC depending on their presence and severity. Methods: The current trial was designed as a case-control study. Data derived from the Acute Cystitis Symptom Score (ACSS) database were analyzed. Diagnostic values of the symptoms and their severity were assessed via the calculations of the sensitivity and specificity, odds ratio, positive and negative likelihood ratios. The strength of associations was estimated by the coefficient of correlation (Pearson’s R). Results: Data from 819 female subjects (423 Patients, 396 controls) with the mean age of 37.1 ± 15.3 were analyzed. Highest diagnostic values for AC in this study belonged to dysuria, urgency, and frequency. Interestingly, complaints of vaginal discharge was not found to decrease the odds for having AC in the study population. Conclusions: The severity of the symptom is even more essential than just its presence for an accurate diagnosis. The ACSS is an accurate tool and may be recommended for clinical practice and studies for diagnosis of AC in women. Further studies and unification of terms are need.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

et al. 2018

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“…Although rUTI in adult women is the leading cause of visits to the doctor's office in the United States [1], the proper management of this condition is not well established because most doctors treat this condition with broad-spectrum antibiotics to ensure a high rate of sterilisation without identifying the bacterial agent by urine culture [5]. We now acknowledge that some patients who present with typical UTI have in fact sterile urine.…”

Section: Discussionmentioning

confidence: 99%

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Rodrigues

Hering²,

Campagnari³

2014

Urol Int

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Objective: To check whether subtle voiding dysfunction is related to recurrent urinary tract infection (rUTI). Methods: 254 consecutive patients with at least four episodes of urinary tract infection (UTI) were studied. At least three repeat urodynamic evaluations with an additional ice water test to maximize the detection of involuntary detrusor contraction (IDC) were used. Stress urinary incontinence cases were used as controls. Nonparametric univariate and multivariate analyses were used for statistics. Results: IDC was detected in 83.6% of patients in the rUTI group and in 31.7% in the control group. IDC was <15 cm H₂O in 54.7% whereas high-amplitude (>50 cm H₂O) IDC was observed in 6.8% in the rUTI group. Female urinary tract obstruction was diagnosed in 16.8% of patients in the rUTI group and in 7.9% in the control group. Residual volume, P_detQ_max and Q_max were not predictive of UTI recurrence. Symptoms were similar in both groups. Conclusions: Patients with rUTI present with covert bladder dysfunctions represented by detrusor overactivity.

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“…In another study, it reveals that symptoms alone have low accuracy when assessed against the reference standard for diagnosing UTI. Empiric treatment of UTI based on symptoms may expose large number of patients to unnecessary antibiotics [7]. A study concluded about antibiotic resistance patterns of outpatient pediatric UTI and has concluded that E. coli remains the most common pediatric uropathogen [8].…”

Section: Discussionmentioning

confidence: 99%

Urinary Tract Infection: Prescribing Pattern of Antibiotics at a Tertiary Care Hospital

Panayappan

2017

Asian J Pharm Clin Res

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Objectives: The purpose of drug utilization review is to ensure drugs are used appropriately, safely, and effectively to improve patient health status. The use of drugs in appropriate, safe, and effective manner would decrease the treatment cost for the patients. Urinary tract infection (UTI) is most common and can lead to secondary infections. Hence, continuous analysis of prescribing pattern in UTI is a vital one. With this information, the study was designed to determine various risk factors and prescribing pattern of rational use of antibiotics in UTI patients at a tertiary care hospital.Methods: A prospective observational study was carried out in 100 patients in a tertiary care teaching hospital, by collecting patient data from the medical records of patients from General Medicine Department.Results: Analysis of prescribed drugs revealed that use of antibiotics such as ceftriaxone (35%) and amikacin (22%) were significantly higher than other drugs prescribed such as ciprofloxacin (16%), nitrofurantoin (15%), ofloxacin (5%), cefixime (3%), moxifloxacin (2%), and clarithromycin (2%). Culture sensitivity test was done only in 30% of the total cases (100) for which empirical treatment had to be applied rather than specific antibiotic treatment. The most common isolated organisms were Escherichia coli (60%), Proteus (20%), Klebsiella (13.33%), and Pseudomonas (6.66%). Conclusion:Cephalosporins, aminoglycosides, and quinolones were the most commonly prescribed antibiotics in this study. Present findings together with previous ones are suggestive of the need for periodic monitoring of antibiotic sensitivity pattern of the bacterial isolates to provide effective treatment.

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Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics?

Cited by 23 publications

References 21 publications

Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

Reliability of Symptom-Based Diagnosis of Uncomplicated Cystitis

Involuntary Detrusor Contraction Is a Frequent Finding in Patients with Recurrent Urinary Tract Infections

Urinary Tract Infection: Prescribing Pattern of Antibiotics at a Tertiary Care Hospital

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