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Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study

Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study
Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study
Objective: To assess the natural course and the important predictors of severe symptoms in urinary tract infection and the effect of antibiotics and antibiotic resistance.

Design: Observational study.

Setting: Primary care.

Participants: 839 non-pregnant adult women aged 18-70 presenting with suspected urinary tract infection.

Main outcome measure: Duration and severity of symptoms.

Results: 684 women provided some information on symptoms; 511 had both laboratory results and complete symptom diaries. For women with infections sensitive to antibiotics, severe symptoms, rated as a moderately bad problem or worse, lasted 3.32 days on average. After adjustment for other predictors, moderately bad symptoms lasted 56% longer (incidence rate ratio 1.56, 95% confidence interval 1.22 to 1.99, P<0.001) in women with resistant infections; 62% longer (1.62, 1.13 to 2.31, P=0.008) when no antibiotics prescribed; and 33% longer (1.33, 1.14 to 1.56, P<0.001) in women with urethral syndrome. The duration of symptoms was shorter if the doctor was perceived to be positive about diagnosis and prognosis (continuous 7 point scale: 0.91, 0.84 to 0.99; P=0.021) and longer when the woman had frequent somatic symptoms (1.03, 1.01 to 1.05, P=0.002; for each symptom), a history of cystitis, urinary frequency, and more severe symptoms at baseline.

Conclusion: Antibiotic resistance and not prescribing antibiotics are associated with a greater than 50% increase in the duration of more severe symptoms in women with uncomplicated urinary tract infection. Women with a history of cystitis, frequent somatic symptoms (high somatisation), and severe symptoms at baseline can be given realistic advice that they are likely to have severe symptoms lasting longer than three days.
0959-8138
b5633-[6pp]
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Merriman, R.
1f1ee6f3-5dc8-46ae-b220-6f7c0bd8c131
Turner, S.
42f19397-8e9f-435d-a348-2cc1639b5eb4
Rumsby, K.
2002ee8a-32ac-4119-869d-ed35164c3b51
Warner, G.
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Lowes, J.A.
eff6751b-62b6-4755-a92e-b1c6e03db3b6
Smith, H.
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Hawke, C.
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Leydon, G.
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Mullee, M.
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Moore, M.V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Merriman, R.
1f1ee6f3-5dc8-46ae-b220-6f7c0bd8c131
Turner, S.
42f19397-8e9f-435d-a348-2cc1639b5eb4
Rumsby, K.
2002ee8a-32ac-4119-869d-ed35164c3b51
Warner, G.
a7c8d450-67a4-46c9-ad1e-4a17d6816590
Lowes, J.A.
eff6751b-62b6-4755-a92e-b1c6e03db3b6
Smith, H.
cc42a332-71ec-436f-8207-9151275a92d8
Hawke, C.
a10de6c7-ee96-4ea1-aa75-571dd87d1e63
Leydon, G.
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
Mullee, M.
fd3f91c3-5e95-4f56-8d73-260824eeb362
Moore, M.V.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Little, P., Merriman, R., Turner, S., Rumsby, K., Warner, G., Lowes, J.A., Smith, H., Hawke, C., Leydon, G., Mullee, M. and Moore, M.V. (2010) Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ, 340, b5633-[6pp]. (doi:10.1136/bmj.b5633). (PMID:20139213)

Record type: Article

Abstract

Objective: To assess the natural course and the important predictors of severe symptoms in urinary tract infection and the effect of antibiotics and antibiotic resistance.

Design: Observational study.

Setting: Primary care.

Participants: 839 non-pregnant adult women aged 18-70 presenting with suspected urinary tract infection.

Main outcome measure: Duration and severity of symptoms.

Results: 684 women provided some information on symptoms; 511 had both laboratory results and complete symptom diaries. For women with infections sensitive to antibiotics, severe symptoms, rated as a moderately bad problem or worse, lasted 3.32 days on average. After adjustment for other predictors, moderately bad symptoms lasted 56% longer (incidence rate ratio 1.56, 95% confidence interval 1.22 to 1.99, P<0.001) in women with resistant infections; 62% longer (1.62, 1.13 to 2.31, P=0.008) when no antibiotics prescribed; and 33% longer (1.33, 1.14 to 1.56, P<0.001) in women with urethral syndrome. The duration of symptoms was shorter if the doctor was perceived to be positive about diagnosis and prognosis (continuous 7 point scale: 0.91, 0.84 to 0.99; P=0.021) and longer when the woman had frequent somatic symptoms (1.03, 1.01 to 1.05, P=0.002; for each symptom), a history of cystitis, urinary frequency, and more severe symptoms at baseline.

Conclusion: Antibiotic resistance and not prescribing antibiotics are associated with a greater than 50% increase in the duration of more severe symptoms in women with uncomplicated urinary tract infection. Women with a history of cystitis, frequent somatic symptoms (high somatisation), and severe symptoms at baseline can be given realistic advice that they are likely to have severe symptoms lasting longer than three days.

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More information

Published date: 5 February 2010
Organisations: Community Clinical Sciences

Identifiers

Local EPrints ID: 143639
URI: http://eprints.soton.ac.uk/id/eprint/143639
ISSN: 0959-8138
PURE UUID: 37e210ca-4efb-4d8a-8a9a-dbca1d0c7e0f
ORCID for K. Rumsby: ORCID iD orcid.org/0000-0002-8573-3718
ORCID for G. Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for M.V. Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 12 Apr 2010 13:56
Last modified: 08 Jan 2022 03:02

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Contributors

Author: P. Little
Author: R. Merriman
Author: S. Turner
Author: K. Rumsby ORCID iD
Author: G. Warner
Author: J.A. Lowes
Author: H. Smith
Author: C. Hawke
Author: G. Leydon ORCID iD
Author: M. Mullee
Author: M.V. Moore ORCID iD

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