According to findings from a study involving six focus groups, fear of overuse of antibiotics and frustration with over-the-counter doctors were the main emotions experienced by women with infections. recurrent urinary tract infections (rUTIs).
“At our women’s pelvic medicine restorative urology clinic in Cedars-Sinai and at UCLA, we’ve seen many women referred for evaluation for rUTIs being very frustrated with their care. them,” Dr. Victoria Scott, Cedars-Sinai Medical Center, Los Angeles, California, told Medscape Medical News.
“So for these focus groups, we see an opportunity to explore why women feel frustrated about the care provided and to try to improve it,” she said. to add.
Findings from the study were published online September 1 in Urology Journal.
The authors write: “There is a need for physicians to revise management strategies… and to devote more research efforts to improvements in the prevention and treatment of recurrent urinary tract infections without antibiotics, as well as as management strategies that better empower patients”.
Six focus groups
Four or five participants were included in each of the six focus groups – 29 women in total. All participants reported a history of episodes of symptomatic UTIs demonstrated by urine culture. They have experienced at least two infections within 6 months or three or more infections within 1 year. Women are mostly white. Most have worked part-time or full-time and have college degrees.
From a qualitative analysis of all the transcripts of this focus group, two main themes emerge:
- Negative effects of taking antibiotics for the prevention and treatment of rUTIs.
- Public outrage over the way rUTIs are managed.
The researchers found that the participants had a clear understanding of the harmful effects of inappropriate antibiotic use, according to media and internet sources. As Scott and his colleagues point out, “Many women say they’ve been prescribed ominously many antibiotics and would refuse to take them to prevent or treat other infections.”
These concerns focus on the risk of developing antibiotic resistance and the adverse effects that antibiotics can have on the gastrointestinal and genitourinary microbiota. Some women report that they have been infected with Clostridium difficile after taking antibiotics; One of the patients was hospitalized because of an infection.
Women also reported concerns that they were being given antibiotics unnecessarily for symptoms that could be caused by a urogenital disease other than a UTI. They also said they felt resentful of the doctors who prescribed them, especially if they felt the doctor was over-prescribing antibiotics. Some have sought the advice of other professionals, such as herbalists. “The second concern discussed by the participants was feelings of being ignored by the doctors,” the authors commented.
In this regard, women who feel their doctors have underestimated the burden that rUTIS places on their lives and the adverse impact that repeated infections have on their relationships. their relationships, jobs and overall quality of life. “These perceptions have led to their widespread suspicion of physicians,” the investigators wrote. This has led many women to stress that more efforts should be devoted to the development of non-antibiotic options for the prevention and treatment of UTIs by the medical community.
Improved management strategy
When asked how doctors can improve their management of rUTIs, Scott shared some suggestions. Basic rule number one: ask the patient to do a urinalysis to make sure she doesn’t have a UTI. “There is a small subset of women with rUTIs who come in with a diagnosis of rUTI but there is really no record of more than one positive urine culture,” Scott notes. Thus, that history indicates no rUTI.
It is imperative that physicians rule out commonly misdiagnosed conditions, such as overactive bladder disease, as the cause of a patient’s symptoms. Symptoms of overactive bladder and rUTIs often overlap. While waiting for results from a urinalysis to confirm or rule out a UTI, young and healthy women may be prescribed a nonsteroidal anti-inflammatory drug (NSAID), such as naproxen, which may help improve symptoms. proof.
Because UTIs often resolve on their own, Scott and others have found that for young, if not otherwise healthy women, NDAIDs alone can often resolve UTI symptoms without use antibiotics. For relatively severe symptoms, urinary pain relievers, such as phenazopyridine (Pyridium), can soothe the lining of the urinary tract and relieve pain. Cystex is an over-the-counter urinary pain reliever that women can buy over-the-counter, Scott adds.
If antibiotics are indicated, those commonly prescribed for an acute episode of cystitis are nitrofurantoin and sulfamethoxazole plus trimethoprim (Bactrim). Scott admits, for recurrent UTIs, “the patient is a bit more complicated.” “I think the best way is to review a woman’s previous urine culture and choose an antibiotic that showed good sensitivity on the most recent positive urine test,” she says.
Prevention begins with behavioral strategies, such as holding urine after sex and wiping from front to back after urinating to prevent bacteria in the stool from entering the urethra. “Evidence shows that premenopausal women who drink as little as 1.5 liters of water per day have significantly fewer episodes of UTIs,” Scott notes. There is also “pretty good” evidence that cranberry supplements (not juices) can prevent rUTIs. Use of Cranberry supplements is supported by the American Urological Association (Conditional recommendation; level of evidence C).
For premenopausal and postmenopausal women, vaginal estrogen may be effective. Its use for UTI prevention is well supported by the literature. Although not supported by strong evidence, some women find that taking supplements such as: D-mannose can prevent or treat UTIs by causing bacteria to attach to it instead of it. into the bladder wall. She notes that Probiotics can also be used. She adds that empathy can heal wounds.
“A common theme among satisfied women is the feeling that their physician understands their problem and has a system in place to enable rapid diagnosis and treatment of episodes of UTIs,” the authors note. .
They wrote: “[Những thái độ như vậy] emphasizes the need to investigate each patient’s experiences and perceptions to enable shared decision-making regarding the management of rUTIs.”
When asked to comment on the finding, the editor, Dr. Michelle Van Kuiken, Associate Professor of Urology, University of California, San Francisco, admitted that unfortunately there is not much strong evidence to support it. advocate for non-antibiotic therapy for the prevention of rUTI. “The AUA guidance clearly shows what evidence actually exists and makes recommendations accordingly,” she told Medscape Medical News in an email. At least one statement in the guidelines is supported by evidence regarding the daily use of concentrated Cranberry supplements, which Van Kuiken generally recommends.
Van Kuiken also routinely recommends the use of vaginal estrogen for all postmenopausal women with recurrent UTIs, although this is also advocated by the AUA for all postmenopausal women on the basis of authentic evidence. There is some evidence to support the use of D-mannose, she admits, although they are not strong.
On the other hand, she feels the evidence supporting the use of probiotics for rUTIs is very poor and she does not routinely recommend them for this indication. “I think for many women who have rUTIs, it can be quite debilitating and uncomfortable – it can affect travel plans, work, and events,” says Van Kuiken. society”.
“Until we develop better diagnostic and treatment strategies, validating women’s experiences and concerns with rUTIs while limiting antibiotic use,” she wrote in her editorial. unnecessary is still our best option.”
Scott and Van Kuiken did not disclose any financial relationship involved.
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Translated by: Thuy Linh