Women with frequent urinary tract infections say they're unhappy with what they perceive as their doctors' overuse of antibiotics and with the limited treatment options available to them, according to a study led by researchers from UCLA and Cedars-Sinai.
The research, recently published in the Journal of Urology, highlights the need for physicians to do a better job finding out why patients get recurrent UTIs, to develop strategies to prevent them and to avoid the unnecessary use of antibiotics, which over time can lead to resistance to the medication.
"Since there's already a common treatment for UTIs — antibiotics — many doctors don't see a need to do anything differently," said senior author Dr. Ja-Hong Kim, an associate professor of urology and assistant fellowship director for female pelvic medicine and reconstructive surgery at UCLA Health. "This study really gave us insight into the patient perspective and showed us those with recurrent UTIs are dissatisfied with the current management of the condition. Continued episodes can have a major impact on their quality of life."
More than half of women will develop a UTI at some point, and roughly 1 in 4 will have repeat infections that can last for years. Many with recurrent infections will be prescribed antibiotics frequently over their lifetime.
The researchers conducted focus groups with 29 women with recurrent UTIs — defined as two infections in six months or three in a year. Participants were asked about their knowledge of UTIs and prevention strategies and about the impact of treatment on their quality of life. These discussions, the researchers said, revealed two common themes: fear and frustration.
Participants' concerns centered primarily on antibiotic use. The women reported a fear of being prescribed multiple courses of antibiotics unnecessarily and developing resistance. Some also reported being treated with antibiotics for symptoms that may have been related to other genitourinary conditions, like an overactive bladder.
"Other bladder diseases can cause symptoms similar to recurrent UTIs, such as urination frequency and urgency, pain with urination and blood in the urine," Kim said. "These could be signs of an overactive bladder, interstitial cystitis, kidney or bladder stones, or something more serious, like bladder cancer. As physicians, we really need to be careful about not just giving patients with these symptoms antibiotics without verifying a UTI through a positive urine culture."
Because a diagnosis currently takes 48 hours, women can wait days before being prescribed the right treatment. These realities clearly spotlight the need for better diagnostic tools, Kim said.
Many participants voiced frustration and resentment toward their medical providers for “throwing antibiotics” at them without presenting alternative options for treatment and prevention, and for not understanding their experience with UTIs. In addition, many said their physicians did not properly educate them on the potential negative impacts of antibiotics; the women instead had to rely on information from the internet, magazines and TV.
Beyond improved diagnostics, treatment approaches and guidelines, better patient education is key, Kim said. “We need to do a better job of letting patients know when antibiotics are necessary and when to consider alternative therapy for bladder conditions other than UTIs."
Kim and her colleagues are currently working to improve UTI diagnosis and management, including developing comprehensive patient-care pathways through which primary care physicians and general gynecologist and urologists will provide initial UTI patient education and management. They are also pursuing studies examining the relationship of the vaginal microbiome to lower urinary tract symptoms and are working to incorporate novel diagnostic methods to allow for point-of-care treatment for UTIs in the hopes of improving patient care.
The study's first author is Victoria Scott, of Cedars-Sinai. Other authors are Taylor Sadun and A. Lenore Ackerman, of UCLA; Melissa Markowitz, of Yale University; Lauren Thum, of Urology Specialists in Sioux Falls, South Dakota; Sally Maliski, of the University of Kansas Medical Center; and Jennifer Anger, of Cedars-Sinai.
