Over Treating Urinary Tract Infections

Medscape reports that urinary tract infection (UTI) is far more common among women than men, with approximately 1 in 3 women experiencing a UTI requiring antimicrobial therapy by 24 years of age. The lifetime prevalence of UTI among women is 40%-50%, and the estimated annual cost of community-acquired UTI in the United States is $1.6 billion.Compounding the overall impact of UTI is an increasing understanding of the wide prevalence of asymptomatic bacteriuria. Asymptomatic bacteriuria is again particularly prevalent among women and is positively associated with age.

From the study by Mishra B, Srivastava S, Singh K, Pandey A, Agarwal J. Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics? Int J Clin Pract. 2012;66:493-498

Medscape has the following Clinical Pearls:

  • UTI is one of the most common infections encountered in clinical practice. However, there is evidence that UTI may be overdiagnosed and overtreated by physicians.
  • In the current study, only 46% of women presenting with UTI symptoms had the infection confirmed on culture.
  • Patient behaviors did not contribute significantly to the diagnosis of UTI.
  • Symptoms significantly related to a higher risk for UTI included urgency, a burning sensation during micturition, and dysuria (painful urination). However, these symptoms had a low specificity for UTI.
  • Adding the presence of pyuria (pus in urine) increased the specificity of symptoms alone.
  • The best predictor of UTI was the combination of urgency, burning during micturition, and pyuria.
  • Physicians should avoid diagnosing UTI in women on the basis of the patient history alone. Urine dipstick testing or urinalysis should be a routine part of the diagnosis of UTI.