A new study finds that women with urinary tract infections are given the wrong antibiotics nearly half the time.
The study, published in the Infection Control & Hospital Epidemiology journal, combed through insurance claims from 670,400 women between the ages of 18 and 44 who were diagnosed with a UTI between April 2011 and June 2015. Researchers compared the antibiotic prescriptions the women were given with up-to-date clinical guidelines. They found that 47 percent of the time, women were given prescriptions for antibiotic treatments that didn’t meet current guidelines.
Women living in rural areas can be particularly impacted: Around 3 out of 4 rural women were given prescriptions that put them on antibiotics for longer than recommended, the study found.
Anne Banfield, an obstetrician-gynecologist in West Virginia, said she is not surprised by the results, adding that the proper use of antibiotics has become a much more relevant topic in the last decade.
“When antibiotics came up, they were sort of a panacea for all things,” she said. Because they were so effective in treating simple but potentially deadly infections, doctors would prescribe them for a variety of conditions that “we wouldn’t even consider doing an antibiotic for now.”
But in the last 10 to 15 years, there’s been much research exploring the harmful effects of overprescribing antibiotics, including the development of increasingly resistant bacteria known as superbugs.
Sonali Advani, an assistant professor of medicine and infectious diseases at Duke University School of Medicine who specializes in UTI research and treatment, particularly for older patients, said she was “very happy” to see more data about the overprescription of antibiotics, noting that older women are especially vulnerable.
“It highlighted an area that has not been covered before in a very high-risk population,” she said.
Prescribing antibiotics when it isn’t necessary can lead to C. difficile, a colon condition that can cause diarrhea, belly pain and fever, as well as serious drug allergies and liver injuries, Advani explained.
A 2011 World Health Organization report found that at least half of all women will report having one or more urinary tract infection in their lifetime. Worldwide, concerns about UTIs prompted more than 8 million annual visits to doctor’s offices and more than 1 million hospitalizations, resulting in costs totaling over a billion dollars.
Despite the prevalence, a number of issues make a proper diagnosis difficult, Advani and Banfield explained.
Not every doctor knows or has access to resources on best practices around antibiotics. This is especially true for older doctors, who have been practicing for decades and may not be aware of updated guidelines, says Banfield. The size of the clinic can also be a limiting factor. Providers working in more remote, rural locations may not have someone trained in infectious diseases on staff, said Banfield.
And women seeking treatment for UTIs in rural places face another hurdle to getting effective, appropriate treatment: time.
UTIs tend to come on suddenly and can feel urgently painful. If you live hours from the nearest doctor or urgent care center, as some of Banfield’s patients do, that already presents an obstacle.
Properly diagnosing a UTI also takes time, because it requires taking a urine sample and assessing whether there’s bacteria. If a patient has trouble even getting into a doctor’s office, both the doctor and the patient might preemptively opt for an antibiotic.
Rural women might also be given longer doses to ensure that the UTI is treated completely without requiring a follow-up visit.
A misunderstanding of how UTIs manifest can also increase the likelihood that someone will get an antibiotic treatment they don’t need.
“People think you either have a UTI or you don’t have a UTI. But UTI is more of a continuum,” Advani explained. People can have asymptomatic bacteria, for example, which means they would test positive for a UTI, but not necessarily need antibiotics.
Doctors can also get anchored to a positive UTI diagnosis, or UTI-like symptoms, without exploring the underlying issues that could be triggering it, she continued. In this way, UTIs can mask other conditions if the provider or patient doesn’t know to look for them.
“The problem that I think we run into, oftentimes, is the rush to diagnosis,” said Banfield.
This was the case for Hannah Srajer, a 26-year-old doctoral student at Yale. At 17, she developed a “really, really bad” UTI infection. She was so embarrassed about it that she didn’t tell her mother right away. When they did go to the doctor — a pediatrician, since Srajer wasn’t yet 18 — she was initially prescribed the wrong antibiotic, given to her before test results came back.
Although the UTI cleared up, she says the initial infection, as well as the delay in treating it, triggered pelvic floor dysfunction. The condition felt like a UTI, which meant that Srajer was shuttled from doctor to doctor, specialist to specialist, and prescribed round after round of antibiotics for nine months. She saw “seven to eight” doctors — pediatricians, urologists, a gyno-urologist and a general practitioner — before she was correctly diagnosed.
Srajer continued having painful symptoms, all while feeling she was the problem. It wasn’t until she went to a physical therapist that her condition improved.
The entire experience was “incredibly isolating, incredibly upsetting,” said Srajer, who says she was reluctant to open up about her experiences until a couple of years ago. She anticipated friends would respond with disgust, but was shocked to see how many people could relate to the pain she felt. If they didn’t personally experience those symptoms, they knew someone ― a friend, a mom, a cousin — who did.
“You start realizing that actually it’s an incredible amount of people who, even if they’re not diagnosed, are having urinary issues, or vulvar pain issues, just pelvic floor issues in general,” she said.
Banfield sees plenty of opportunity to build on the research from the recent study.
She noted that the study focuses on women who have private insurance, and not those on Medicaid (a group that makes up between 40 to 50 percent of her patients). Banfield would like to see what they experience when they try to get a UTI treated. She also wants to see more demographic information around providers — whether the gender of your provider affects your treatment or how doctors across different fields address UTIs.
Because different types of doctors will see patients with UTI symptoms, Advani advocates for more multidisciplinary approaches to treating UTI patients, as well as greater investment from hospitals and health-care organizations to improve outcomes for patients.
“We need to fix the underlying problem, not just give antibiotic prophylaxis.”