Symptom Documentation Before Antibiotics for Recurrent Urinary Tract Infections

ImportanceDocumentation of symptoms in the medical record before prescribing antibiotics for urinary tract infection (UTI) could promote antibiotic stewardship.ObjectiveThe aim of this study was to describe the number and type of symptoms documented across specialties during encounters where an antibiotic was prescribed to older women with recurrent UTI.Study DesignWe conducted a retrospective cohort study of women aged 65 years or older with a diagnosis of recurrent UTI. Patients were included if they had been prescribed an antibiotic for UTI at least twice in 6 months or 3 times in 1 year. Data on number and type of symptoms and urine culture results were extracted and compared across encounters and specialties.ResultsA total of 454 encounters from 175 patients were analyzed. The majority of encounters were in primary care (61.8%), followed by urology/urogynecology (24%), obstetrics and gynecology (9.2%), and emergency department/urgent care (4.8%). The median number of UTI-specific symptoms recorded across specialties was 1 (interquartile range, 0-2) and declined in subsequent encounters. The number of UTI-specific symptoms documented was none in 25%, 1 in 26%, and 2 or more in 49% of encounters. Of the 337 encounters with positive cultures, 19% had no documented UTI-specific symptoms and 9% had no documented symptoms of any kind.ConclusionsDocumentation of urinary symptoms during encounters where antibiotics are prescribed is sparse across specialties for older patients with recurrent UTI. The gap in care identifies an opportunity for improving antibiotic stewardship through improved documentation of urinary symptoms.