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The rise of antibiotic resistant bacteria poses one of the biggest threats to human health. In a Government report on the threat of increasing bacterial resistance, the UK chief medical officer  described it “as big a risk as terrorism”, reported the BBC.

A number of factors contribute to this problem, one of the main reasons being the misuse and overuse of antibiotics. Even in countries where antibiotics are only available from a doctor, over-prescribing and unnecessary use are still common (Nature News. 2011 Nov 22). It has been suggested that patient expectations have a large part to play in this (BMJ 1998; 317); the view being that patients will request immediate treatment with antibiotics – even when advised against this by their physician. It was this assumption that Bart Knottnerus and colleagues at the University of Amsterdam set out to test, as published in a recent study in BMC Family Practice. The study tested women’s willingness to delay antibiotic use when consulting their doctor with symptoms of urinary tract infections (UTIs).

UTIs are a common condition in women, and although they are not a serious infection, symptoms are bothersome and can reduce quality of life. Guidelines often recommend immediate treatment with antibiotics for adult patients presenting with UTI symptoms. However, past studies (BMJ 2005; 331) have shown that in 25-50 percent of women, symptoms will disappear by themselves within a week. The question then arises: is it true that patients with UTI symptoms expect and demand treatment with antibiotics?

To find the answer, Knottnerus and colleagues requested GPs taking part in the study to ask patients presenting with typical UTI symptoms to delay antibiotic treatment for one week. More than a third of patients were prepared to do so, leading the authors to conclude that the perception, common among clinicians, that patients expect immediate treatment is not always correct. Over 70 percent of patients who delayed treatment showed improved symptoms after a week.

Although the results demonstrate that some patients are willing to delay treatment, almost two thirds of women in the study preferred to begin treatment immediately to alleviate their uncomfortable symptoms as soon as possible. In addition, almost half of the women who initially agreed to delay treatment did in fact use antibiotics before the week was out.

Even with these caveats, this study makes an important contribution to the debate on reducing the unnecessary use of antibiotics. The authors conclude with the suggestion that ‘as a safe alternative to antibiotics (without the risk of bacterial resistance), symptomatic treatment may be offered’. Offering pain relief instead of immediate antibiotics has already been suggested as a potential alternative in UTI treatment  (BMC Med 2010, 8:30, BMC Infect Dis 2012, 12:146).


Written by Christopher Foote, Executive Edito for the BMC Series.


Research article

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