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Woman, Heal Thyself

Some recurrent bladder infections are better treated by the patient herself, study says

FRIDAY, July 6, 2001 (HealthDayNews) -- Some women who have chronic problems with urinary tract infections are better off if they can dose themselves with antibiotics without waiting for a doctor's prescription, says a new study.

Patient-initiated treatment for UTIs works well and seems to be a safe way of treating these unpleasant infections, the study found.

"Patient-initiated therapy is a practice that's been relatively common among some providers, but it's never been actually validated in a study of this sort in a primary care setting," says Dr. Kalpana Gupta, the study's lead author and an acting instructor of medicine at the University of Washington School of Medicine in Seattle.

UTIs are a very common infection, right behind respiratory infections, and they account for more than 8 million visits to doctors' offices every year in the United States.

UTIs occur when such bacteria as Escherichia coli, chlamydia or mycoplasma invade the normally sterile urinary tract and spread into the urethra and bladder. Symptoms include the frequent urge to urinate and a painful, burning sensation during urination.

Women are far more prone to UTIs than men, with one woman in five developing a UTI during her lifetime. Almost 20 percent of those who get one UTI will get a second, and in that group, 30 percent will get a third. And 80 percent of those will keep getting the infections.

Gupta and her colleagues enrolled 172 healthy, non-pregnant women who had had at least two UTIs in the previous year in the study. The women's average age was 23.

Each woman received a kit for obtaining urine samples and a three-day supply of antibiotics. They were told to collect a urine sample if they started to develop UTI symptoms, then immediately start the course of antibiotics.

The researchers then tested the urine sample to see whether the woman actually had a urinary tract infection, and followed up to see if the patient's symptoms disappeared. Once the three-day course of antibiotics was complete, the researchers asked for another urine sample, and if the infection persisted, the woman was sent to a doctor.

Over the course of a year, 88 of the study participants reported 172 episodes of symptoms, with some women having more than one episode. Of those, an infection was confirmed in 84 percent of the cases, while another 11 percent had possible infections.

Ninety-two percent of the women who started taking the antibiotics reported that the symptoms disappeared; 96 percent of the follow-up urine specimens showed that the infection had been wiped out.

"I think the most important thing is that the provider and the patient have a good relationship and the patient clearly understands that the medication is to be used specifically for UTI symptoms, not for other indications," says Gupta.

The researchers also stress that this approach is only possible in a select group of people. Self-treatment may not be safe in older or ill women, those who are pregnant, or in men with UTIs.

Also, the study didn't compare its findings against a group of women who sought medical attention for UTIs, or who were taking preventive antibiotics to ward off recurrent UTIs.

Most of the women said they were highly satisfied with being able to treat their symptoms themselves. They reported that they were comfortable with the process, had been able to start treatment earlier and had UTI symptoms for a shorter period of time than if they had consulted a health-care provider before starting therapy.

The study's results were reported in the July 3, 2001, Annals of Internal Medicine.

Dr. Andrew Herxheimer, an emeritus fellow at the United Kingdom Cochrane Centre in Oxford, England, and the author of a related editorial, said the self-treatment "puts [patients] at a different place on the control-dependency continuum. If they know they can manage themselves, then that puts them in control and that's very positive." If they still run into problems, they know that they can consult an expert, Herxheimer adds.

But, he addes, although the findings point to the potential benefits of self-management programs, "we can't just assume that they're going to work." He says that doctors will need to build in fail-safe checks and ensure that patients actually understand what they should be doing.

"These results really need to be put into practice by doctors," says Herxheimer.

Gupta adds that this could ultimately have a clinical impact. "It's feasible, although we did not test it in this study, that this approach would actually decrease the cost of treating recurrent UTI. An office visit isn't needed for each event."

"This study provides validation for the fact that women with recurrent UTI can recognize their symptoms and can safely and accurately treat themselves."

What To Do

The Food and Drug Administration, the National Institute of Diabetes & Digestive & Kidney Diseases and the University of Illinois at Urbana-Champaign all provide excellent information on urinary tract infections.

SOURCES: Interviews with Kalpana Gupta, M.D., M.P.H., acting instructor of medicine, Division of Allergy & Infectious Diseases, University of Washington School of Medicine, Seattle, Wash.; Andrew Herxheimer, M.D., emeritus fellow, United Kingdom Cochrane Centre, Oxford, U.K.; July 3, 2001, Annals of Internal Medicine
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