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Patient-Initiated Treatment of Uncomplicated Recurrent Urinary Tract Infections in Young Women

Kalpana Gupta, MD, MPH; Thomas M. Hooton, MD; Pacita L. Roberts, MS; and Walter E. Stamm, MD
[+] Article and Author Information

From the University of Washington, Seattle, Washington.


Presented in part at the 1998 and 2000 annual meetings of the Infectious Diseases Society of America (Denver, Colorado, and New Orleans, Louisiana) and at the Sixth International Symposium on New Quinolones, Denver, Colorado, 1998.

Disclaimer: Dr. Gupta has served as a consultant for and received research support and speaking honoraria from Procter & Gamble and Bayer Pharmaceutical. Dr. Hooton has received research support and speaking honoraria from Ortho-McNeil Pharmaceutical, Procter & Gamble, Bristol-Meyers Squibb, Pfizer, and Bayer Pharmaceutical. Dr. Stamm has served as a consultant for and received research support and honoraria from Procter & Gamble, Ortho-McNeil Pharmaceutical, and Bayer Pharmaceutical.

Acknowledgments: The authors thank Mary B. Watts, MD, and the staff at Hall Health Primary Care Center for assistance with patient enrollment; Carol Winter, ARNP, and Natalie DeShaw, Research Study Coordinator, for patient enrollment and follow-up and database management; and Cheryl Wobbe, Cindy Fennell, Sheila Manuguid, Shuli Denton, and Marsha Cox for careful microbiological studies.

Grant Support: In part by the National Institutes of Health (DK 47549 and DK 53369) and by Ortho-McNeil Pharmaceutical, Raritan, New Jersey.

Requests for Single Reprints: Kalpana Gupta, MD, MPH, Department of Medicine/Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Box 356523, University of Washington, Seattle, WA 98195; e-mail, kalg@u.washington.edu.

Current Author Addresses: Drs. Gupta, Hooton, and Stamm and Ms. Roberts: Department of Medicine/Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Box 356523, University of Washington, Seattle, WA 98195.

Author Contributions: Conception and design: K. Gupta, T.M. Hooton, W.E. Stamm.

Analysis and interpretation of the data: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Drafting of the article: K. Gupta, T.M. Hooton.

Critical revision of the article for important intellectual content: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Final approval of the article: K. Gupta, T.M. Hooton, P.L. Roberts, W.E. Stamm.

Statistical expertise: P.L. Roberts.

Obtaining of funding: T.M. Hooton, W.E. Stamm.

Administrative, technical, or logistic support: K. Gupta, T.M. Hooton, W.E. Stamm.

Collection and assembly of data: K. Gupta, P.L. Roberts.


Ann Intern Med. 2001;135(1):9-16. doi:10.7326/0003-4819-135-1-200107030-00004
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Urinary tract infection (UTI) is an exceedingly common outpatient problem, accounting for more than 8 million office visits and $1 billion in health care costs per year. Approximately 50% to 70% of women will have a UTI sometime during their lifetimes, and 20% to 30% of women will have recurrent episodes (13). Thus, safe and effective management strategies that have the potential to improve patient convenience and decrease costs are of considerable interest to patients, providers, and health care organizations. The most well-studied and commonly accepted approach to managing recurrent UTIs uses low-dose antimicrobial prophylaxis given postcoitally, three times per week, or daily (46). This strategy has been shown to be safe and highly effective, even after 5 years of use. However, studies of the natural history of recurrent UTI demonstrate substantial variability in the number of recurrences experienced per woman (range, 0.3 to 7.6 episodes per year) (7). In addition, recurrences often cluster in time. Thus, continuous prophylaxis may result in unnecessary antimicrobial use in women who have infrequent recurrences or clustered recurrences. An alternative strategy, namely patient self-diagnosis and self-treatment of recurrent UTIs, may decrease antimicrobial use and improve patient convenience. However, this strategy has been evaluated in only two previous studies, both in relatively small groups of older women referred to specialty clinics for management of recurrent UTI (89). To establish the safety and feasibility of this approach in a larger and more generalized sample, we assessed the accuracy of self-diagnosis and the cure rates seen with self-treatment of UTIs in 172 women who had a history of recurrent infection and were attending a university-based primary care clinic.

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Figures

Grahic Jump Location
Figure 1.
Proportion of women who initiated treatment for symptoms of urinary tract infections during each month of follow-up.

Most patient-initiated treatment episodes occurred during the first 6 months of follow-up.

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Figure 2.
Diagnostic accuracy and outcomes of 172 patient-initiated treatment episodes of recurrent urinary tract infection (UTI).

* Sterile pyuria was defined as ≥ 10 leukocytes per high-power field.

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Summary for Patients

Patient-Initiated Treatment of Recurrent Urinary Tract Infection in Women

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.

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