Women's experiences with antibiotic use in urinary tract infections: Insights from the patient's perspective

  • Aleksandar Jovanović University of Niš, Faculty of Medicine, Department of Pharmacy, Niš, Serbia; PhD student at University of Belgrade - Faculty of Pharmacy, Belgrade, Serbia
  • Milica Drobac University of Belgrade – Faculty of Pharmacy, Department of Pharmacognosy, Belgrade, Serbia
  • Ivana Tadić University of Innsbruck, Faculty of Chemistry and Pharmacy, Department of Clinical Pharmacy, Innsbruck, Austria
  • Bojana Vidović University of Belgrade - Faculty of Pharmacy, Department of Bromatology, Belgrade, Serbia
  • Dragana Pavlović University of Niš - Faculty of Medicine, Department of Pharmacy, Niš, Serbia
  • Radmila Veličković Radovanović University of Niš, Faculty of Medicine, Department of Pharmacology with Toxicology, Niš, Serbia
  • Marina Odalović University of Belgrade – Faculty of Pharmacy, Department for Social Pharmacy and Pharmaceutical Legislation, Belgrade, Serbia
  • Ana Kundalić University of Niš, Faculty of Medicine, Department of Pharmacy, Niš, Serbia
  • Predrag Džodić University of Niš, Faculty of Medicine, Department of Pharmacy, Niš, Serbia
  • Dušanka Krajnović University of Belgrade – Faculty of Pharmacy, Department for Social Pharmacy and Pharmaceutical Legislation, Belgrade, Serbia
Keywords: antibiotic use, patient report, self-treatment, guideline adherence

Abstract


From patients’ perspective, the use of antibiotics to treat urinary tract infections (UTIs) in Serbia is unexplored, and therefore the aim of this study is to examine antibiotic use among these patients. An online cross-sectional study using snowball sampling was conducted during the winter of 2020/21 using a validated Google Docs questionnaire. The study included 236 female patients with a mean age of 34.9 ± 14.2 years. Most of the patients perceived UTI symptoms as severe (62.3%) and disruptive for their daily routines (51.3%). The majority of the patients (77.1%) used antibiotics by doctors’ prescriptions. Other patients used antibiotics on their own and their selection. Self-treatment with antibiotics was associated with perceived symptom severity (p=0.006) and residence (p=0.017). In total, 17 different antibiotics were reported as being used for UTI treatment and the most frequent were fluoroquinolones (30.3%), cephalosporins (21.2%), and sulfonamides (15.7%). The highest consistency with national and European guidelines in doctors’ decisions on antibiotic therapy was observed for treating UTIs in pregnant women (80.0%). These findings emphasize the need for education of healthcare professionals and clinical practice improvement in making rational antibiotic prescribing decisions.

 

 

 

References

Belamarić G, Bukumirić Z, Vuković M, Spaho RS, Marković M, Marković G, et al. Knowledge, attitudes, and practices regarding antibiotic use among the population of the Republic of Serbia - A cross-sectional study. J Infect Public Health. 2023;16 Suppl 1:111–8.

Horvat OJ, Tomas AD, Paut Kusturica MM, Savkov AV, Bukumirić DU, Tomić ZS, et al. Is the level of knowledge a predictor of rational antibiotic use in Serbia? PLoS One. 2017;12:e0180799.

Antimicrobial resistance surveillance in Europe 2023–2021 data [Internet]. World Health Organization; 2025 [cited 2025 Mar 19]. Available from: https://www.who.int/europe/publications/i/item/9789289058537.

Little P, Merriman R, Turner S, Rumsby K, Warner G, Lowes JA, et al. Presentation, pattern, and natural course of severe symptoms, and role of antibiotics and antibiotic resistance among patients presenting with suspected uncomplicated urinary tract infection in primary care: observational study. BMJ. 2010;340:b5633.

Durkin MJ, Keller M, Butler AM, Kwon JH, Dubberke ER, Miller AC, et al. An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections. Open Forum Infect Dis. 2018;5:ofy198.

Chan AJ, O’Donnell D, Kaasa B, Mathers A, Papaioannou A, Brazil K, et al. Barriers and facilitators of implementing an antimicrobial stewardship intervention for urinary tract infection in a long-term care facility. Can Pharm J (Ott). 2021;154:100–9.

Marchaim D, Gottesman T, Schwartz O, Korem M, Maor Y, Rahav G, et al. National multicenter study of predictors and outcomes of bacteremia upon hospital admission caused by Enterobacteriaceae producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 2010;54:5099–104.

Ortega M, Marco F, Soriano A, Almela M, Martínez JA, Muñoz A, et al. Analysis of 4758 Escherichia coli bacteraemia episodes: predictive factors for isolation of an antibiotic-resistant strain and their impact on the outcome. J Antimicrob Chemother. 2009;63:568–74.

Peña C, Gudiol C, Calatayud L, Tubau F, Domínguez MA, Pujol M, et al. Infections due to Escherichia coli producing extended-spectrum beta-lactamase among hospitalised patients: factors influencing mortality. J Hosp Infect. 2008;68:116–22.

Linsenmeyer K, Strymish J, Gupta K. Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections. Antimicrob Agents Chemother. 2015;59:7593–6.

Bonkat G, Kranz J, Cai T, Geerlings S, Köves B, Pilatz A, et al. European Association of Urology Guidelines on Urological Infections [Internet]. European Association of Urology; 2025 [cited 2025 Mar 19]. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2025_2025-05-24-110339_pxmf.pdf.

Prevention and Treatment of Uncomplicated Urinary Tract Infections: National Guide to Good Clinical Practice. Belgrade: Ministry of Health of the Republic of Serbia, 2022.

Alkhawaldeh R, Abu Farha R, Abu Hammour K, Alefishat E. Optimizing antimicrobial therapy in urinary tract infections: A focus on urine culture and sensitivity testing. Front Pharmacol. 2022;13:1058669.

Frimodt-Møller N, Bjerrum L. Treating urinary tract infections in the era of antibiotic resistance. Expert Rev Anti Infect Ther. 2023;21(12):1301–8.

Jovanović A, Drobac M, Vidović B, Pavlović D, Krajnović D, Tadić I. Herbal products versus antibiotics for urinary tract infections-analysis of patient attitudes. J Herb Med. 2024;46:100892.

Bush K, Courvalin P, Dantas G, Davies J, Eisenstein B, Huovinen P, et al. Tackling antibiotic resistance. Nat Rev Microbiol. 2011;9:894–6.

Scott VCS, Thum LW, Sadun T, Markowitz M, Maliski SL, Ackerman AL, et al. Fear and Frustration among Women with Recurrent Urinary Tract Infections: Findings from Patient Focus Groups. J Urol. 2021;206:688–95.

Yakovlev SV, Suvorova MP. Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review. Ter Arkh. 2022;94:1006–13.

Paterson DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis. 2004;38 Suppl 4:S341–5.

Quinolone- and fluoroquinolone-containing medicinal products [Internet]. European Medicines Agency; 2019 [cited 2025 May 13]. Available from: https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products.

Wu C, Xiao Y, Jing Y, Yin Q, Bao Y. New insights into the solubilization of multicomponent crystals: A case study of pipemidic acid. Cryst Growth Des. 2023;23:3367–83.

Pirrone A, Avantaggiato M, Panzeri F. 5PSQ-002 Prescribing trend of fluoroquinolones following latest EMA recommendations. Eur J Hosp Pharm. 2024;31:A163-A164.

Batista AD, A Rodrigues D, Figueiras A, Zapata-Cachafeiro M, Roque F, Herdeiro MT. Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review. Antibiotics (Basel). 2020;9(11):786.

Asogwa PO, Sarella PNK. Observational studies of prescription pattern and use of antibiotics in selected rural areas. Int J Pharm Sci Med. 2023;8:21–30.

Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S. Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC Womens Health. 2021;21:44.

Gizaw Z, Astale T, Kassie GM. What improves access to primary healthcare services in rural communities? A systematic review. BMC Prim Care. 2022;23:313.

Bennett AC, Bennett CL, Witherspoon BJ, Knopf KB. An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms/dissections disseminated by the Food and Drug Administration and the European Medicines Agency. Expert Opin Drug Saf.2019;18:1055–63.

DE Nunzio C, Nacchia A, Lombardo R, Franco A, Cicione A, Trucchi A, et al. Is EMA warning on quinolones and fluoroquinolones really assessed? An EudraVigilance database analysis. Minerva Urol Nephrol. 2023;75:374–80.

Hooton TM, Roberts PL, Stapleton AE. Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: a randomized trial. JAMA. 2012;307:583–9.

Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stamm WE. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. JAMA. 2005;293:949–55.

Butler CC, Francis N, Thomas-Jones E, Llor C, Bongard E, Moore M, et al. Variations in presentation, management, and patient outcomes of urinary tract infection: a prospective four-country primary care observational cohort study. Br J Gen Pract. 2017;67:e830–e841.

Pothoven R. Management of urinary tract infections in the era of antimicrobial resistance. Drug Target Insights.2023;17:126–37.

Zec S, Despotovic A, Spurnic-Radovanovic A, Milosevic I, Jovanovic M, Pelemis M, et al. Antimicrobial resistance in patients with urinary tract infections and the impact on empiric therapy in Serbia. J Infect Dev Ctries.2016;10:1065–72.

Velickovic-Radovanovic RM, Stefanovic NZ, Damnjanovic ID, Petrovic JD, Mitic RV, Kocic BD, et al. The analysis of antibiotic consumption and bacterial resistance in tertiary Healthcare Centre Nis. Hosp Pharmacol - Int Multidiscip.J. 2016;3:341–7.

Lazarević J, Nikolić B, Malešević Z, Ninković V. Antibiotic resistance of causes of urinary tract infections in patients at the Public Health Institute Kragujevac. Zdravstvena zaštita. 2022;51:56–71.

Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. CMAJ.2017;189:E625–E633.

Yefet E, Schwartz N, Chazan B, Salim R, Romano S, Nachum Z. The safety of quinolones and fluoroquinolones in pregnancy: a meta-analysis. BJOG. 2018;125:1069–76.

Published
2025/08/31
Section
Original scientific paper