Self-treatment of UTIs safe and feasible
Self-diagnosis and self-treatment with antimicrobials
of urinary tract infection (UTI) in women with recurrent infections is
safe and feasible, researchers have found.
Dr Kalapna Gupta and colleagues from the University
of Washington, Seattle, investigated the feasibility of patient-initiated
treatment of UTIs in 172 young women. All had had at least two UTIs in
the previous 12 months.
Management of recurrent UTI is commonly based on
use of low-dose antimicrobial prophylaxis. However, variability in the
number of recurrences means that continuous prophylaxis can result in
unnecessary antimicrobial use, they say.
After self-diagnosing a UTI, women in the study
collected a urine sample before commencing a three-day course of either
ofloxacin or levofloxacin that they were given at the start of the study.
Presence of infection was determined by tests on the urine sample.
The women were followed up for between two and 12
months (mean eight months). During the study, 88 women self-diagnosed
a total of 172 infections. Mild genitourinary symptoms that were not considered
indicative of UTI were reported by 64 women. Of 169 episodes where antimicrobial
therapy was initiated, 94 per cent (95 per cent confidence interval, 90
to 99 per cent) of infections were microbiologically confirmed.
Clinical cure of infection was observed in 92 per
cent of cases and only 6 per cent of women ultimately required antimicrobial
prophylaxis for management of recurrent infection. In addition, 84 of
the 172 women did not have an infection during the study. The authors
conclude that self-diagnosis and self-treatment “greatly reduced the overall
antibiotic usage that would have occurred if prophylaxis was routinely
prescribed to all study women”. However, they caution that the approach
should only be used for women with uncomplicated UTIs who could accurately
follow the study protocol.
Patient satisfaction was high. Women reported that
they were comfortable with the process of self-diagnosis and self-treatment,
that they could start therapy earlier and that they had a shorter duration
of symptoms compared with previous episodes of UTI managed traditionally
(ie, by consulting a health care provider before starting therapy).
(Annals of Internal Medicine 2001; 135:9.)
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