First Do No Harm - Urinary Tract Infections

Women, unfortunately, get urinary tract infections (UTIs) all the time.  The usual complaints are pain with peeing, frequent urination and pain below the belly button.  In otherwise healthy women, a simple three day antibiotic course of Bactrim or Ciprofloxin (both $4 for all the pills at most pharmacies these days), easily treats the UTI.

Now, occasionally clinicians find bacteria in women's urine during routine screening while the women may have no symptoms.  In fact, there can be upwards of 100,000 cfu/ml (colony forming units per milliliter of urine) without symptoms.  We, as a field of medicine, used to assume that given the high bacterial load and the risks associated with UTIs, these asymptomatic bacteruria episodes should be treated.

That is, until about the late 1990s, when we realized that we're actually doing more harm than good.  We were subjecting women to the small, but substantial, risks of side-effects and adverse reactions from the antibiotics, while not reducing the chance the bacteria would return.  It turned out that even if the antibiotics cleared the bacteria for this one episode, the bacteria eventually returned, and unfortunately, they would have learned to resist the previous antibiotic - meaning we'd have to sequentially use stronger and stronger antibiotics.

So there were guidelines and recommendations from all the major bodies - the USPSTF, the AFP, IDSA and so forth - though clinicians were very skittish regarding following this guideline.  It just seemed a great leap of faith to know that a women has a significant amount of bacteria in her urine and still do absolutely nothing about it.  And yet, as these guidelines from the USPSTF again state - we should still do nothing about them. 

(The only exception to this is pregnant women - where the bacteria may affect the fetus...)

Picture used from flickr.com user  未知(みち).  Thanks.

Comments

[Carrie]

does this apply also to the severely immunocomprimised? whilst i will probably never take antibiotics for a uti or yeast infection ever again in my life (as my experience is that the infections very often return with strength or chronicity), i am wondering if this is safe advice for the aforementioned women... got any ideas?