Women's quality of life is decreased by acute cystitis and antibiotic adverse effects associated with treatment.
BACKGROUND
Although acute cystitis is a common infection in women, the impact of this infection and its treatment on women's quality of life (QOL) has not been previously described.


OBJECTIVE
To evaluate QOL in women treated for acute cystitis, and describe the relationship between QOL, clinical outcome and adverse events of each of the interventions used in the study.


METHODS



METHODS
Randomized, open-label, multicenter, treatment study.


METHODS
Two family medicine outpatient clinics in Iowa.


METHODS
One-hundred-fifty-seven women with clinical signs and symptoms of acute uncomplicated cystitis.


METHODS
Fifty-two patients received trimethoprim/sulfamethoxazole 1 double-strength tablet twice daily for 3 days, 54 patients received ciprofloxacin 250 mg twice daily for 3 days and 51 patients received nitrofurantoin 100 mg twice daily for 7 days.


METHODS
QOL was assessed at the time of enrollment and at 3, 7, 14 and 28 days after the initial visit. QOL was measured using a modified Quality of Well-Being scale, a validated, multi-attribute health scale. Clinical outcome was assessed by telephone interview on days 3, 7, 14 and 28 using a standardized questionnaire to assess resolution of symptoms, compliance with the prescribed regimen, and occurrence of adverse events.


RESULTS
Patients experiencing a clinical cure had significantly better QOL at days 3 (p = 0.03), 7 (p < 0.001), and 14 (p = 0.02) compared to patients who failed treatment. While there was no difference in QOL by treatment assignment, patients experiencing an adverse event had lower QOL throughout the study period. Patients treated with ciprofloxacin appeared to experience adverse events at a higher rate (62%) compared to those treated with TMP/SMX (45%) and nitrofurantoin (49%), however the difference was not statistically significant (p = 0.2).


CONCLUSIONS
Patients experiencing cystitis have an increase in their QOL with treatment. Those experiencing clinical cure have greater improvement in QOL compared to patients fail therapy. While QOL is improved by treatment, those reporting adverse events have lower overall QOL compared to those who do not experience adverse events. This study is important in that it suggests that both cystitis and antibiotic treatment can affect QOL in a measurable way.
Ernst
Erika J
EJ
College of Pharmacy, University of Iowa, Iowa City, IA, USA. erika-ernst@uiowa.edu
Ernst
Michael E
ME
Hoehns
James D
JD
Bergus
George R
GR
D000208:Acute Disease; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000009:adverse effects / Q000627:therapeutic use; D003556:Cystitis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D009582:Nitrofurantoin / Q000009:adverse effects / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use*
D000892:Anti-Infective Agents, Urinary; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin