Urinary tract infections in healthy women: a revolution in management?
BACKGROUND
Urinary infection in otherwise healthy women has largely been a straightforward matter of diagnosis by identifying bacteria in the urine, and then cure by appropriate antibiotics. Recent research has shown this to be over-simplified. Evaluation of methods of self-management of symptoms has been neglected.


CONCLUSIONS
Firstly trial data show that women with what used to called 'urethral syndrome' (urinary symptoms but sterile urine) obtain relief from antibiotics. Other trial data have shown a surprisingly large placebo effect from the resolution of symptoms among women who feel their care has been 'positive'. In addition, data published this month in BMC Medicine show that non-steroidal anti-inflammatory (NSAID) drugs provide symptom relief to women with conventional infections (positive urine bacteriology) as much as antibiotics.


CONCLUSIONS
These recent findings provide an opportunity to consider how clinicians might change practice, and sets a new research agenda. We need to know (1) whether the effect of NSAIDs is replicable; (2) why some women in previous trials have had more symptoms if not treated with antibiotics sooner; (3) whether NSAIDs and antibiotics have an additive effect on relieving symptoms; (4) how we can harness the placebo effect better to assist out patients with this distressing and common complaint. See research article http://www.biomedcentral.com/1741-7015/8/30.
Del Mar
Chris
C
School of Medicine, Faculty of Health Sciences, Bond University, Queensland 4229, Australia. cdelmar@bond.edu.au
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001437:Bacteriuria / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D001628:Beverages; D001639:Bicarbonates / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D019468:Disease Management; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000379:methods; D005260:Female; D006302:Health Services Research; D006801:Humans; D015990:Placebo Effect; D012648:Self Care / Q000379:methods; D029799:Vaccinium macrocarpon
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001639:Bicarbonates