Department of General Practice, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2/D7, 97080, Würzburg, Germany.
Department of General Practice, Göttingen University Medical Center, Humboldtallee 38, 37073, Göttingen, Germany.
BMC Infect Dis. 2020 Nov 9;20(1):813. doi: 10.1186/s12879-020-05377-w.
Uncomplicated urinary tract infections (UTIs) in women are usually managed in primary care with antibiotics. However, many women seem to prefer to handle UTI symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs) and other remedies. The aim of this study was to compare UTI management as recommended by physicians with the patients' management at home.
This prospective cohort study in German primary care is based on clinical data from local practices and patient questionnaires. Participating women completed a baseline data sheet in the practice; their urine sample was tested by a dipstick in the practice and cultured by a laboratory. The women reported treatment and symptom-related impairment on an eight-item symptom questionnaire daily for 7 days. Using growth curve models, we analysed the influence of time on the total severity score to examine how symptoms changed across days. We then examined whether symptom severity and symptom course differed between patients who took antibiotics or NSAIDs.
A total of 120 women (mean age of 43.3 ± 16.6 years) were enrolled. The urine dipstick was positive for leucocytes in 92%, erythrocytes in 87%, and nitrites in 23%. Physicians prescribed antibiotics for 102 (87%) women and recommended NSAIDs in 14 cases. According to the women's reports, only 60% (72/120) took antibiotics, while the remainder took NSAIDs and other remedies. Symptoms declined from day 0 to day 6, irrespective of whether women decided to take an antibiotic, NSAIDs, none or both, as confirmed by a significant curvilinear time effect (B = 0.06, SE = 0.005, p < .001). The symptom course, however, was moderated by taking antibiotics so that the change in symptom severity was somewhat more pronounced in women taking antibiotics (B = 0.06) than in the remainder (B = 0.04).
A substantial proportion of women did not follow their physicians' treatment recommendations, and many used NSAIDs. All women had a good chance of recovery irrespective of whether they decided to take antibiotics. A sensitive listening to patient preferences in the consultation may encourage physicians to recommend and prescribe symptomatic treatment with NSAID more often than antibiotic medicines.
女性单纯性尿路感染（UTI）通常在初级保健机构用抗生素治疗。然而，许多女性似乎更喜欢用非甾体抗炎药（NSAIDs）和其他药物来缓解 UTI 症状。本研究旨在比较医生推荐的 UTI 治疗方法与患者在家中的治疗方法。
这是一项在德国初级保健机构进行的前瞻性队列研究，基于当地诊所的临床数据和患者问卷调查。参与的女性在诊所填写基线数据表；她们的尿液样本在诊所使用试条进行检测，在实验室进行培养。女性在 7 天内每天使用八项症状问卷报告治疗和症状相关的损害情况。使用增长曲线模型，我们分析时间对总严重程度评分的影响，以检查症状在不同天数的变化情况。然后，我们检查了接受抗生素或 NSAIDs 治疗的患者之间症状严重程度和症状过程是否存在差异。
共纳入 120 名女性（平均年龄 43.3±16.6 岁）。尿试条白细胞阳性 92%，红细胞阳性 87%，亚硝酸盐阳性 23%。医生为 102 名（87%）女性开了抗生素，为 14 名女性推荐了 NSAIDs。根据女性的报告，只有 60%（72/120）服用了抗生素，而其余女性则服用了 NSAIDs 和其他药物。无论女性决定服用抗生素、NSAIDs、还是两者都不服用，症状都从第 0 天到第 6 天逐渐减轻，这一点通过显著的曲线时间效应得到证实（B=0.06，SE=0.005，p<.001）。然而，症状过程受到服用抗生素的影响，因此在服用抗生素的女性中，症状严重程度的变化更为明显（B=0.06），而在其余女性中则不那么明显（B=0.04）。
相当一部分女性没有遵循医生的治疗建议，许多人使用 NSAIDs。无论女性是否决定服用抗生素，她们都有很好的康复机会。在咨询中敏感地倾听患者的偏好可能会鼓励医生更经常地推荐和开 NSAID 对症治疗，而不是抗生素药物。
