Telephone management of presumed cystitis in women: Factors associated with recurrence

Objective: To determine the factors associated with short-term risk for urinary tract infection (UTI) recurrence after telephone management of cystitis. Patients and setting: Retrospective cohort study of consecutive patients treated by a regional call center of a large group-model health maintenance organization. A total of 4177 women, aged 16 to 97 years (median, 39 years), were managed over the telephone for presumed cystitis with 3 to 7 days of oral antimicrobial therapy. 2933 (70.2%) received cephalexin 250 mg 4 times daily; 600 (14.4%) received trimethoprim-sulfamethoxazole double-strength twice daily; 408 (9.8%) received nitrofurantoin 100 mg 4 times daily; and 236 (5.7%) received ciprofloxacin 250 mg twice daily. Main outcome measure: UTI recurrence within 6 weeks of index telephone management. Results: During the 6-week follow-up period, 644 women (15.4%; 95% confidence interval [CI], 14.3%-16.6%) were diagnosed with UTI. Two factors were independently associated with recurrence in a Cox proportional hazards model: age 70 years (P = 0.003) and antimicrobial selection (P = 0.031). Adjusted hazard ratios in reference to trimethoprim-sulfamethoxazole showed a significant risk reduction only with cephalexin: cephalexin, 0.75 (95% CI, 0.61-0.93); ciprofloxacin, 0.85 (95% CI, 0.59-1.22); and nitrofurantoin, 0.95 (95% CI, 0.70-1.28). Conclusion: Short-term risk for UTI recurrence after telephone management of presumed cystitis is associated with advanced age and antimicrobial selection. These factors may be useful for identifying patients who may benefit from more aggressive management or careful follow-up.

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