Urinary tract infections | heart disease differences | cancer prognosis tool | Australia and U.S. COVID-19 comparison
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What are the best treatment options for uncomplicated urinary tract infections?
Hello and welcome to this week's Health Report. I'm Norman Swan.
And I'm Tegan
Taylor. Today, why women are different when it comes to heart disease and how these differences may affect treatment.
You'll hear from Dr Tony Fauci, who's overseeing the US response to COVID-19, including vaccination.
A better way to communicate and calculate cancer prognosis and survival for patients as well as doctors.
and urinary tract infections, UTIs, including the dreaded cystitis, peeing, razor blades. Many women and some men know the symptoms, that needing to go to the toilet constantly with that painful burning. But for something that's so common, there's often confusion on how best to treat them. Do antibiotics help and to what extent? What about over-the-counter remedies? Well, new research has brought together the most reliable evidence on treating UTIs to see when it's appropriate to take a wait-and-see approach. And one of its authors joins us now. Tammy Hoffman, welcome to The Health Report. Hi, Tegan. Hi, Norman. So most women would know this as cystitis. Is that what we're talking about today? Yes, so uncomplicated urinary tract infection.
And what did your study find was the best way to treat them?
So we actually looked at what happens if you don't treat a UTI, usually because the conventional kind of practice has always been to offer antibiotics. We were actually interested in what happens if you don't treat with antibiotics and you just wait and see, does it fall into the category of sort of one of these self-remitting diseases that gets better spontaneously. So we did a systematic review of any randomized trial that had a placebo group, which the placebo didn't treat. And so there were only three trials that have looked at this that had a placebo group. Most of them had compared different types of antibiotics. And we found that about a third of women seemed to get better within the first week without any antibiotic treatment.
Why is this sort of research important?
Because an antibiotic overuse is a big problem. So one of the antibiotics that's commonly used to treat UTI is trimethoprim, and it's got quite high resistance rates. And so as well as the problem of resistance, if you take an antibiotic that you may not need, there's also the problem of the side effects that a lot of women have. a lot of people experience with antibiotics, so rash and diarrhea and vomiting. So if there's a condition for which a treatment is not needed, in this case antibiotics, then the option of not treating should be explicitly explained to the patient as being a legitimate option.
I mean, having a UTI sucks, I speak from personal experience. Are women willing to wait or do they just want medication straight away?
So some of the research that's looked at this, so the option that we were saying should be explicitly explained is something called a wait and see with a sort of a backup prescription. So they're given the prescription and said just... but a list of kind of red flags, things to be aware of to watch her if it does get worse. So the women have got the prescription if they decide to use it. And so that option of sort of just waiting and seeing but with a backup prescription, some of the studies that have looked at the acceptability of that have found that up to about half of patients find that an acceptable option.
So this paper is part of a series that's aiming to help doctors help their patients make informed decisions using a framework called shared decision making and part of the goal is to reduce antibiotic use. What kind of barriers are there for patients and doctors when it comes to reaching a shared decision?
So I think knowing that what all the options are. So in this series of papers or projects that we've been doing where one option is explicitly not treat and just kind of a wait and watch or wait and see. I think there's little awareness among clinicians and the public that actually just waiting and seeing is often a legitimate option. Also, then there needs to be some talk about what the benefits and the harms are of all the options, so the do nothing or the immediately treat.
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Chapters
8 chapters
1
What are the best treatment options for uncomplicated urinary tract infections?
0:00–4:53
2
When is a ‘wait‑and‑see’ approach appropriate for UTIs and how does it work?
4:53–9:56
3
How can shared decision‑making help patients choose between antibiotics and no treatment for UTIs?
9:56–14:56
4
Do over‑the‑counter remedies have any proven benefit for cystitis?
14:56–18:55
5
Why do heart disease symptoms and risk factors differ between men and women?
18:55–23:58
6
What did the gene‑regulatory network study reveal about sex‑specific atherosclerosis pathways?
23:58–29:16
7
How does the new online cancer‑survival tool help patients understand their prognosis?
29:16–33:41
8
What lessons can Australia learn from the United States’ COVID‑19 response and vaccine rollout?
33:41–36:03
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