SINGAPORE – A large local study of polyclinic patients has found that not all the antibiotics used to treat urinary tract infections (UTIs) were as appropriate, and there is a need for better diagnosis and management of the condition in primary care.
Two out of four antibiotics that are usually prescribed for uncomplicated UTIs were found to be more superior and resulted in a lower risk of treatment failure. Patients were less likely to return to the clinic due to persistent symptoms or head to the emergency department because of complications.
UTI is usually caused by bacteria, and the symptoms include pain when urinating, increased frequency of urination, and cloudy urine. The infection is very common – about half of all women will experience it at least once in their life.
The study from 2019 to 2021 involved 3,194 female patients, aged 18 to 50, with uncomplicated UTIs from six National University Polyclinics.
Uncomplicated UTIs happen in healthy people with normal urinary tracts. Complicated UTIs, which may require longer or stronger antibiotic courses, were excluded from the study.
This is the first large-scale local study in primary care done on uncomplicated UTIs in Singapore. Titled “Antibiotic treatment failure of uncomplicated urinary tract infections in primary care”, it was published in the journal Antimicrobial Resistance and Infection Control on Aug 1.
The study recommends using amoxicillin-clavulanate (commonly known as Augmentin) or nitrofurantoin for treating uncomplicated UTIs in Singapore.
These are antibiotics with lower reported resistance rates, and have lower treatment failure rates compared to ciprofloxacin and co-trimoxazole, said the study’s first author, Dr Sky Koh, an associate consultant and family physician at Bukit Batok Polyclinic.
He said patients who took Augmentin or nitrofurantoin were 33 per cent less likely to experience treatment failure, compared to those who took the other two antibiotics.
“You might not be able to clear the bacteria in the urinary tract altogether using the other two antibiotics because the bacteria has become more resistant to them over the years,” he said.
Dr Koh said the other significant finding was that doctors relied on urine tests to diagnose UTIs, even though international guidelines recommend diagnosing the condition based on symptoms only. In the study, only 26 per cent of the UTIs were diagnosed based on symptoms.
The guidelines also do not recommend collecting urine cultures for lab tests to diagnose uncomplicated UTIs, but local doctors do so for about one-third of the cases.
A urine test will tell if a person has a UTI, while a lab test on urine cultures will identify which bacteria is growing, and this will help doctors decide which antibiotics to prescribe.
“Most of the time, UTIs can be diagnosed in an uncomplicated way in non-pregnant women, pre-menopausal women between the ages of 18 and 50. It’s actually quite common, and we can use symptoms to diagnose them,” said Dr Koh.
“We usually don’t send urine cultures because the tests cost $40 and the bacteria is going to be what we have predicted, which is Escherichia coli,” he said.