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Experts say antibiotics are many times prescribed before lab results return for a suspected urinary tract infection. Mego Picturae
  • In a new study, researchers say half of women are given the wrong antibiotic for a urinary tract infection.
  • Experts say this is done many times because a medication is prescribed before lab results come back.
  • Experts urge women who believe they have an infection to insist on a urine culture and wait for results before taking antibiotics.

Nearly half of women treated for urinary tract infections (UTIs) start out and often stay on the wrong antibiotic.

That’s the finding from a recent study out of Washington University in St. Louis published in the journal Infection Control & Hospital Epidemiology of the Society for Healthcare Epidemiology of America.

Experts say the research is important for people fighting a urinary tract infection, as well as for antibiotic use overall.

“Antibiotics are serious medicine and need to be used in a thoughtful way,” Dr. Katherine Campbell, MPH, medical director of labor and birth, maternal special care unit at Yale New Haven Hospital in Connecticut, told Healthline.

“We are now in about our third generation of (having antibiotics available), and there are real consequences from antibiotic resistance,” she added.

The recent study was designed to look at the differences in antibiotics prescribed to women in urban areas versus rural areas.

While the study authors anticipated finding more challenges in one area above another, they found that the issue exists across the board.

The researchers noted that nearly half of the 670,450 women in the study received the wrong antibiotic and often were kept on antibiotics too long.

“Given that uncomplicated UTIs are one of the most common indications for antibiotic prescribing in otherwise healthy populations, we wanted to identify targets for interventions designed to improve guideline adherence,” Anne Mobley Butler, PhD, a study author and an assistant professor of medicine and surgery at the Washington University School of Medicine, told Healthline.

“Although we observed differences between rural and urban prescribing, inappropriate prescribing was rampant in both rural and urban settings,” she added.

Women in rural areas were more likely to be on antibiotics for a longer time than needed, but overall, the prescribing issues showed in equal measures across the board.

Why is this important?

It can mean a delay in improvement in symptoms, and this overuse of medication can have long-term impacts.

“We now understand there are a myriad of issues with (incorrect or overdone) antibiotic use,” Dr. Felice Gersh, who treats thousands of women as founder and director of the Integrative Medical Group of Irvine in California, told Healthline. “It disrupts our microbiome.”

This isn’t a case of doctors not understanding or caring, said Gersh.

Rather, she said, it comes from a combination of different antibiotics working better in different regions and a tendency to treat for a UTI before culture testing is back.

Antibiotics that are used frequently in regions can become less effective.

Infectious agents can build up resistance to them and then that antibiotic can become less powerful.

Amoxicillin is a great example, Gersh said.

“It used to be the first in line, but now it’s just not as effective,” she said. “Resistant strains are so prevalent, it’s not the standard anymore.”

This situation gets complicated for providers, as the answer isn’t an across-the-board solution.

But drilling down and understanding how and when and which antibiotics to prescribe would help, Butler said.

“Promoting optimal antimicrobial exposure — including appropriate agent and duration — benefits the patient and society by preventing avoidable adverse events, microbiome disruption, and antibiotic-resistant infections,” she said.

“Inappropriate antibiotic use is associated with increased risk of treatment failure, adverse events, antibiotic resistance, and healthcare costs,” she added.

Butler said she hopes the study spurs action.

“Accumulating evidence suggests that shifts in prescribing practices — from broad- to narrow-spectrum agents and longer to shorter durations — can reduce adverse outcomes at the patient level,” she noted.

There’s another thing at play as well. Many providers wanting to provide relief for a patient prescribe an antibiotic before culture results are in.

UTIs can grow different bacteria, and the only way to know which one — and therefore which antibiotic fights it best — is to wait the 3 days it takes for that culture to grow in a lab, Campbell said.

Gersh pointed out that UTIs can be somewhat simple or more complicated and involve the kidneys.

This study only looked at women with uncomplicated UTIs, but Gersh said that knowing and understanding the level of the UTI informs providers on which antibiotic to choose.

So, too, does waiting on lab results.

Many providers, she said, may “wonder if it is impacting the kidneys and treat (with an antibiotic for that) just in case,” she said.

They also may worry that a patient may not come back for financial or other reasons and prescribe an antibiotic immediately so the person will have one.

“They’re trying to be thoughtful,” she said.

That, most experts agree, may need to change.

“If you are not immunocompromised or pregnant, there is no need to immediately treat (a UTI),” Gersh said.

Waiting would be the best bet for using the proper medication for the right amount of time, she said.

What’s a person who may suspect a UTI to do?

Be ready to ask questions, and be willing to wait, experts say.

Some steps that Gersh suggests:

Be clear with your symptoms

Be ready to share your urination frequency and urgency, your pain level, and if you’ve had a fever.

Writing this down ahead of time, particularly if you’re feeling ill and distressed, is a good plan, she said.

“Especially in the age of telemedicine,” Gersh said.

Insist on a urine culture

Even if your provider is sure it’s a UTI, ask for the test.

“We need to know exactly what bacteria is growing on your bladder,” Gersh said.

Even with a repeated UTI, she stresses this.

“It’s not rare for a woman to have repeated infections, but then we have to know if it is the same bacteria, if it’s becoming resistant, or if it’s something else completely,” she said.

“You don’t really know what you have if you don’t actually know what is going on,” she said.

Be willing to wait

First, don’t take an antibiotic from home without asking, Gersh said.

In addition, patience can pay off.

“There’s no reason to immediately treat,” she said. “Antibiotics did not exist 100 years ago, and women still got UTIs and they weren’t dying from them.”

Gersh suggests self-treating with hydration and herbal remedies until the culture returns.

You may even find, she said, that things begin to correct with just that.

“We want to try to allow our bodies to heal themselves,” she said.

As for practitioners, Butler hopes the study results help bring focus to the situation and that there’s more focus on drilling down to the proper medication.

Campbell said she believes the answer could begin to come via electronic medical records.

Those records, she said, should track a person’s past illnesses and medications as well as results, and can be used to better assess UTI needs in the future.

“Even as an equalizer for urban and rural areas,” she said. “It’s a great example of how we can better this. For an uncomplicated thing like a UTI, it should be doable.”