Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women

Ann Intern Med. 2001 Jul 3;135(1):9-16. doi: 10.7326/0003-4819-135-1-200107030-00004.


Background: Recurrent urinary tract infections (UTIs) are a common outpatient problem, resulting in frequent office visits and often requiring the use of prophylactic antimicrobial agents. Patient-initiated treatment of recurrent UTIs may decrease antimicrobial use and improve patient convenience.

Objective: To determine the safety and feasibility of patient-initiated treatment of recurrent UTIs.

Design: Uncontrolled, prospective clinical trial.

Setting: University-based primary health care clinic.

Participants: Women at least 18 years of age with a history of recurrent UTIs and no recent pregnancy, hypertension, diabetes, or renal disease.

Intervention: After self-diagnosing UTI on the basis of symptoms, participating women initiated therapy with ofloxacin or levofloxacin.

Measurements: Accuracy of self-diagnosis determined by evidence of a definite (culture-positive) or probable (sterile pyuria and no alternative diagnosis) UTI on pretherapy urinalysis and culture. Women with a self-diagnosis of UTI that was not microbiologically confirmed were evaluated for alternative diagnoses. Post-therapy interviews and urine cultures were used to assess clinical and microbiological cure rates, adverse events, and patient satisfaction.

Results: 88 of 172 women self-diagnosed a total of 172 UTIs. Laboratory evaluation showed a uropathogen in 144 cases (84%), sterile pyuria in 19 cases (11%), and no pyuria or bacteriuria in 9 cases (5%). Clinical and microbiological cures occurred in 92% and 96%, respectively, of culture-confirmed episodes. No serious adverse events occurred.

Conclusion: Adherent women can accurately self-diagnose and self-treat recurrent UTIs.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Algorithms
  • Anti-Infective Agents, Urinary / therapeutic use*
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Levofloxacin*
  • Middle Aged
  • Ofloxacin / therapeutic use*
  • Patient Compliance
  • Patient Satisfaction
  • Prospective Studies
  • Reagent Kits, Diagnostic
  • Recurrence
  • Self Administration
  • Self Care*
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / drug therapy*


  • Anti-Infective Agents, Urinary
  • Reagent Kits, Diagnostic
  • Levofloxacin
  • Ofloxacin