Physicians may underestimate severity of cystitis symptoms

OB/GYN News, Nov 15, 2004 by Bruce Jancin

ORLANDO, FLA. -- A perception gap exists between women with acute cystitis and their physicians in terms of assessment of symptom severity, Richard Colgan, M.D., said at WONCA 2004, the conference of the World Organization of Family Doctors.

He presented a survey of more than 9,000 physicians and acute cystitis patients that demonstrated physicians tend to underestimate the impact of acute cystitis-related symptoms on affected patients' quality of life.

The survey involved 1,972 American physicians--54% of them family physicians and 30% internists--and 7,254 of their acute cystitis outpatients. The survey was conducted prior to treatment as part of a Bayer Pharmaceuticals Corp.-sponsored prospective open-label phase IV study of the safety and efficacy of a new once-daily extended-release formulation of ciprofloxacin.

The three symptoms under scrutiny in the survey were urgency, frequency, and dysuria. Physicians and their acute cystitis patients agreed on the severity of each of these symptoms in 54%-57% of cases. However, 32% of patients rated their dysuria as significantly more severe than did their physicians.

Similarly, 28% of patients rated their urgency as more severe than their physicians did. And in 26% of cases, patients rated their urinary frequency a more severe problem than did their physicians.

When physicians underestimate disease severity or patients are unable or reluctant to provide an accurate description of the severity of their symptoms, misdiagnosis and/or undertreatment may ensue, said Dr. Colgan of the University of Maryland, Baltimore.

Conversely, when physicians assess symptom severity as being greater than their patients do, as occurred with regard to dysuria, frequency, and urgency in 14%-17% of cases in this large survey, the result may be overtreatment using the more expensive antimicrobials--and a hastening of antibiotic resistance.

BY BRUCE JANCIN

Denver Bureau