Women's quality of life is decreased by acute cystitis and antibiotic adverse effects associated with treatment

Abstract

Background: Although acute cystitis is a common infection in women, the impact of this infection and its treatment on women's quality of life (QOL) has not been previously described.

Objectives: To evaluate QOL in women treated for acute cystitis, and describe the relationship between QOL, clinical outcome and adverse events of each of the interventions used in the study.

Design: Randomized, open-label, multicenter, treatment study.

Setting: Two family medicine outpatient clinics in Iowa.

Patients: One-hundred-fifty-seven women with clinical signs and symptoms of acute uncomplicated cystitis.

Intervention: Fifty-two patients received trimethoprim/sulfamethoxazole 1 double-strength tablet twice daily for 3 days, 54 patients received ciprofloxacin 250 mg twice daily for 3 days and 51 patients received nitrofurantoin 100 mg twice daily for 7 days.

Measurements: QOL was assessed at the time of enrollment and at 3, 7, 14 and 28 days after the initial visit. QOL was measured using a modified Quality of Well-Being scale, a validated, multi-attribute health scale. Clinical outcome was assessed by telephone interview on days 3, 7, 14 and 28 using a standardized questionnaire to assess resolution of symptoms, compliance with the prescribed regimen, and occurrence of adverse events.

Results: Patients experiencing a clinical cure had significantly better QOL at days 3 (p = 0.03), 7 (p < 0.001), and 14 (p = 0.02) compared to patients who failed treatment. While there was no difference in QOL by treatment assignment, patients experiencing an adverse event had lower QOL throughout the study period. Patients treated with ciprofloxacin appeared to experience adverse events at a higher rate (62%) compared to those treated with TMP/SMX (45%) and nitrofurantoin (49%), however the difference was not statistically significant (p = 0.2).

Conclusion: Patients experiencing cystitis have an increase in their QOL with treatment. Those experiencing clinical cure have greater improvement in QOL compared to patients fail therapy. While QOL is improved by treatment, those reporting adverse events have lower overall QOL compared to those who do not experience adverse events. This study is important in that it suggests that both cystitis and antibiotic treatment can affect QOL in a measurable way.

Figure 1

Diagram of patient enrolment and analysis.

Figure 2

Quality of Life for all patient at each follow up contact.

Figure 3

Quality of Life in patients by clinical outcome at each follow up contact.

Figure 4

Quality of Life in patients by urine culture results at each follow up contact.

Figure 5

Change in quality of life by drug treatment over the study period.

Figure 6

Patient quality of life by adverse event experience at each follow up contact.