Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women.
BACKGROUND
Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience.


OBJECTIVE
To determine the safety and feasibility of patient-initiated treatment of recurrent UTIs.


METHODS
Uncontrolled, prospective clinical trial.


METHODS
University-based primary health care clinic.


METHODS
Women at least 18 years of age with a history of recurrent UTIs and no recent pregnancy, hypertension, diabetes, or renal disease.


METHODS
After self-diagnosing UTI on the basis of symptoms, participating women initiated therapy with ofloxacin or levofloxacin.


METHODS
Accuracy of self-diagnosis determined by evidence of a definite (culture-positive) or probable (sterile pyuria and no alternative diagnosis) UTI on pretherapy urinalysis and culture. Women with a self-diagnosis of UTI that was not microbiologically confirmed were evaluated for alternative diagnoses. Post-therapy interviews and urine cultures were used to assess clinical and microbiological cure rates, adverse events, and patient satisfaction.


RESULTS
88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogen in 144 cases (84%), sterile pyuria in 19 cases (11%), and no pyuria or bacteriuria in 9 cases (5%). Clinical and microbiological cures occurred in 92% and 96%, respectively, of culture-confirmed episodes. No serious adverse events occurred.


CONCLUSIONS
Adherent women can accurately self-diagnose and self-treat recurrent UTIs.
Gupta
K
K
Department of Medicine/Division of Allergy and Infectious Diseases, 1959 NE Pacific Street, Box 356523, University of Washington, Seattle, WA 98195, USA.
Hooton
T M
TM
Roberts
P L
PL
Stamm
W E
WE
D000328:Adult; D000465:Algorithms; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D064704:Levofloxacin; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use*; D010349:Patient Compliance; D017060:Patient Satisfaction; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012008:Recurrence; D012646:Self Administration; D012648:Self Care; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
D000892:Anti-Infective Agents, Urinary; D011933:Reagent Kits, Diagnostic; D064704:Levofloxacin; D015242:Ofloxacin