Indiscriminate antibiotic prescribing for nonspecific symptoms perpetuates gender-based healthcare inequities

Abstract

Urinary tract infection is among the most common bacterial infection among adults, and women are significantly more likely to experience urinary tract infection than men. The prevalence of urinary tract infection in women increases with age, as does the prevalence of noninfectious lower urinary tract symptoms and asymptomatic bacterial colonization of the urinary tract, known as asymptomatic bacteriuria. Distinguishing among these 3 entities is challenging without a complete clinical evaluation, including history, physical examination, and urine culture data. Existing literature demonstrates high misclassification of nonspecific symptoms, such as urinary tract infection, among women. In addition, less than one-fifth of diagnoses meet evidence-based criteria for urinary tract infection. Therefore, women are burdened by several healthcare inequities, including delays in care for potentially life-threatening conditions, antibiotic resistance and antibiotic-associated adverse events because of overreliance on antibiotics for noninfectious symptoms, and distrust of medical care. Profit-driven pressures imposed by our healthcare system, which reward providers for increasing clinical volume at the expense of quality patient-provider interactions, are a major culprit driving these inequities. In addition, lack of provider knowledge regarding urinary tract infection–confusable diagnoses, discomfort with pelvic examinations, and inappropriate use of automated question-based algorithms to diagnose and treat urinary tract infection are to blame. An evidence-based approach incorporating a focused history and physical examination that is concordant with the patient’s chief complaint in addition to urine culture data only in cases of suspected urinary tract infection is the only way to reduce urinary tract infection–related healthcare inequities unfairly confronting women.