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Open Access Highly Accessed Research article

Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study

Bart J Knottnerus1*, Suzanne E Geerlings2, Eric P Moll van Charante1 and Gerben ter Riet1

Author Affiliations

1 Department of General Practice, Academic Medical Center - University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands

2 Department of Internal Medicine / Infectious Diseases, Academic Medical Center - University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands

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BMC Family Practice 2013, 14:71  doi:10.1186/1471-2296-14-71

Published: 31 May 2013

Abstract

Background

Women presenting with symptoms of acute uncomplicated urinary tract infection (UTI) are often prescribed antibiotics. However, in 25 to 50% of symptomatic women not taking antibiotics, symptoms recover spontaneously within one week. It is not known how many women are prepared to delay antibiotic treatment. We investigated how many women presenting with UTI symptoms were willing to delay antibiotic treatment when asked by their general practitioner (GP).

Methods

From 18 April 2006 until 8 October 2008, in a prospective cohort study, patients were recruited in 20 GP practices in and around Amsterdam, the Netherlands. Healthy, non-pregnant women who contacted their GP with painful and/or frequent micturition for no longer than seven days registered their symptoms and collected urine for urinalysis and culture. GPs were requested to ask all patients if they were willing to delay antibiotic treatment, without knowing the result of the culture at that moment. After seven days, patients reported whether their symptoms had improved and whether they had used any antibiotics.

Results

Of 176 women, 137 were asked by their GP to delay antibiotic treatment, of whom 37% (51/137) were willing to delay. After one week, 55% (28/51) of delaying women had not used antibiotics, of whom 71% (20/28) reported clinical improvement or cure. None of the participating women developed pyelonephritis.

Conclusions

More than a third of women with UTI symptoms are willing to delay antibiotic treatment when asked by their GP. The majority of delaying women report spontaneous symptom improvement after one week.

Keywords:
Urinary tract infections; General practice; Antibiotics; Delayed treatment; Natural course