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Can You Skip Antibiotics for Urinary Tract Infection?
Date:6/4/2013

By Kathleen Doheny
HealthDay Reporter

TUESDAY, June 4 (HealthDay News) -- Some women with symptoms of a urinary tract infection may be able to skip the antibiotics typically prescribed and have their symptoms improve or clear, according to a new Dutch study.

"In healthy people, many mild infections can be cured spontaneously," said study leader Dr. Bart Knottnerus, a researcher at the Academic Medical Center of the University of Amsterdam.

A U.S. expert, however, had a number of cautions about the findings, including the small number of women studied.

For the research, published May 31 in the journal BMC Family Practice, Knottnerus recruited women from 20 general medical practices in and around the Netherlands from 2006 to 2008. Women who had contacted their doctor complaining of frequent urination, painful urination or both were asked if they would be willing to delay antibiotics -- but only if their symptoms had been present for no longer than seven days.

Certain women were excluded, including those pregnant or breast-feeding or those whose immune systems were compromised.

In all, 176 women participated. Of those, 137 were asked to delay antibiotics and 51 agreed. All the women gave a urine sample to be analyzed and cultured. The women reported on their symptoms over the next week.

After a week, 28 of the 51 women willing to delay antibiotic use still had not used an antibiotic. Twenty of these women (71 percent) reported disappearance or improvement of their symptoms. Of these 20, more than a third had a positive culture result, indicating an infection. The researchers did not know the culture results at the start of the study.

Most of the women not willing to delay antibiotics had a positive culture.

The women who did agree to delay, Knottnerus said, might be aware of the bacterial resistance that can result from antibiotic use. "Furthermore," he said, "in the Netherlands, other mild infections -- like eye, ear, throat and respiratory infections -- are usually not treated with antibiotics. Therefore, people might be more receptive to delayed antibiotic prescriptions."

Antibiotics for urinary tract infections usually work within two or three days. How would an infection clear on its own? "Our defense mechanisms are strong and often do not need any help from antibiotics," Knottnerus said. He studied only uncomplicated infections of the bladder -- defined as those in healthy, non-pregnant women.

Dr. Jennifer Leighdon Wu, a gynecologist at Lenox Hill Hospital in New York City, was cautious about the findings. "The number of women who agreed to delay was 51," she said. "Before changing my practice, I would like to see much larger numbers."

Checking in with your doctor might uncover some other problem, she said. "I can't tell you how many people have come in thinking it's a urinary tract infection and it's a yeast infection," she said.

In her practice, Wu will sometimes prescribe antibiotics right away, especially if a woman is in pain. For others, she may wait until the culture comes back, which usually takes about three days. "If you can wait until the culture comes back, the patient will probably receive more appropriate antibiotics," she said, as the doctor can then target the antibiotic to the organism found in the culture.

"You have to be really careful about who you are asking to forego antibiotic treatment," she said. It could be especially dangerous in older patients. The women in the study, on average, were in their early 40s.

Antibiotics are needed if a woman has symptoms such as fever, shivering and flank pain, Knottnerus said, as this may indicate the infection has progressed to the kidneys.

As for cranberry juice, which some women use to self-treat, Knottnerus said there is no hard evidence that it works to treat infections, but it may help prevent them.

More information

To learn more about urinary tract infections, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Bart Knottnerus, M.D., researcher, Academic Medical Center, University of Amsterdam, the Netherlands; Jennifer Leighdon Wu, M.D., obstetrician-gynecologist, Lenox Hill Hospital, New York City; May 31, 2013, BMC Family Practice


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