Woman on laptop being prescribed antibiotics for a UTI virtually

Can antibiotics for a UTI be prescribed virtually?

Written on January 3, 2023 by Lori Mulligan, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Virtual doctors can prescribe antibiotics for UTIs through telehealth visits. However, it depends upon a number of factors — for example, whether the patient has a simple or complicated history of UTIs, or how conservative the doctor is in conducting virtual visits.

Over 50% of women will experience a urinary tract infection (UTI) in their lifetime. As UTIs are often painful, they are a common reason to seek care, resulting in over 10 million outpatient visits and 1 million emergency department visits in the United States annually. Healthcare costs associated with UTIs are estimated at over $2 billion per year [1].

Let’s take a look at some of the pros and cons of treating UTIs virtually (and consider scheduling an appointment for online UTI treatment).

Everlywell VCV offering

Pros

Telemedicine has several potential advantages, including convenience, efficiency (avoiding travel and saving time), and lower costs. Furthermore, telehealth visits can be provided by the patient's primary care provider instead of at an emergency department or urgent care center. Also, if a patient is having difficulty getting an appointment with a primary care provider, they can call one of the 24/7 virtual telehealth centers and speak with a healthcare provider who is qualified to prescribe antibiotics.

Cons

The main concerns about telehealth visits focus on quality issues: whether healthcare providers can make accurate diagnoses without a real face-to-face interview or physical examination, whether the lack of tests and follow-up visits is appropriate, and whether antibiotics might be overprescribed. An overprescription of antibiotics immediately raises a red flag about the potential for resistance. Also, consumers do not need to go through their primary care provider to get antibiotic prescriptions. They can access a 24/7 online business with on-call providers poised to prescribe antibiotics without knowing the patient’s history, for example, whether the patient is high-risk or not [2]. Also, the patient does not know the credentials of the doctor so it is a leap of faith that he or she is qualified.

While it’s helpful to brainstorm pros and cons of telehealth visits for treating UTIs, it is essential to explore what evidence-based research there is that lends some clarity and insight, and provides guidance.

Research Paper #1: Management of urinary tract infections in direct-to-consumer (DTC) telemedicine

The purpose of this cross-sectional observational study is to describe management of UTIs in a large, nationwide DTC telemedicine platform. The participants are patients seeking care for or diagnosed with UTI via DTC telemedicine between July 2016 and July 2018 [3].

Key Findings

Of the 20,600 patients diagnosed with a UTI during the study period, 96% were female. Most (84%) stated their call reason was a UTI. Receipt of an antibiotic was associated with higher satisfaction with care. Of the 6% of the study population defined as high risk, 69% received an antibiotic: 72% of males, 91% of women over 65, and 21% of patients diagnosed with pyelonephritis [3].

Conclusion

Management of UTI via DTC telemedicine appears to be appropriate for average-risk patients, and most are able to self-diagnose. Most patients received guideline-concordant care, but over half of high-risk patients received antibiotics. This study demonstrated that DTC telemedicine offers convenient, low-cost care that is generally appropriate. Efforts should be made to ensure high-risk patients get the proper follow-up [3].

Research Paper 2: Clinical practice review on telehealth for managing a population with chronic urinary tract infections during the COVID-19 pandemic

The aim of this clinical practice review was to identify the key successes of telehealth when caring for a population diagnosed with a chronic UTI during the COVID-19 pandemic [3].

Findings and Conclusion

The available literature on telehealth, population health management, and chronic UTI during the COVID-19 pandemic has demonstrated a sustainable and cost-efficient method for managing a population group with a chronic illness.

Undoubtedly, there is a need to monitor and evaluate the effectiveness of telehealth within this population group to eliminate information disparities and failed follow-up consultations.

Healthcare professionals should be adequately trained on how to effectively use telehealth when conducting consultations and follow-up appointments and evaluate the risks of bypassing patient groups who are not digitally competent to actively participate in telehealth for managing their chronic UTIs [4].

Research Paper #3: Comparison of eVisit management of urinary symptoms and urinary tract infections with standard care

The purpose was to compare antibiotic prescribing, follow-up rates, and clinical outcomes between Face 2 Face (F2F) visits at a retail clinic, nurse phone protocol encounters, and eVisits for the assessment and management of urinary symptoms and UTIs [5].

Results

Antibiotic prescribing rates for all three encounter types were similar. Referral for follow-up at an initial encounter was more likely to be recommended from phone and eVisit encounters than F2F. No significant differences in follow-up rates or clinical outcomes were noted between the three encounter types [5].

Conclusions

eVisits for urinary symptoms and UTI offer patients a convenient option for care without an increased use of antimicrobials, follow-up, or adverse clinical outcomes when compared with F2F visits or nurse-administered phone protocols [5].

The future: integrating antimicrobial stewardship into UTI telehealth programs

Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing and use is critical to effectively treating infections, protecting patients from harms caused by unnecessary antibiotic use, and combating antibiotic resistance.

CDC’s Core Elements of Antibiotic Stewardship offer providers and facilities a set of key principles to guide efforts to improve antibiotic use and, therefore, advance patient safety and improve outcomes.

CDC recognizes that there is no “one size fits all” approach to optimize antibiotic use for all settings. The complexity of medical decision-making surrounding antibiotic use and the variability in facility size and types of care in U.S. healthcare settings require flexible programs and activities.

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate

The objective was to analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols.

Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. The researchers analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics.

Here are some highlights [6]:

  • Studies suggest that telemedicine (TM) increases antibiotic prescription rates.
  • Researchers analyzed 6,050 TM visits performed under rigorous antibiotic stewardship.
  • Most acute low-risk infectious conditions were adequately managed by TM.
  • TM under stewardship was associated with low and adequate rates of antibiotic prescription.

Conclusion

A low prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms.

Summary

Telemedicine holds great promise for managing antibiotic prescriptions for UTIs. As a matter of fact, Everlywell offers fast, easy telehealth visits. Address your symptoms with the right test, prescriptions, and lifestyle recommendations. Major insurance plans accepted. A care plan from a nurse practitioner, and technology that protects your privacy. Visit Everlywell's option for UTI treatment online to schedule an appointment.

Everlywell VCV offering

You can get UTI antibiotics online: here's how

What diagnoses can you get online?

How can I get rid of a UTI in 24 hours without medication?

References

  1. Bruxvoort KJ, Bider-Canfield Z, Tartof SY, et al. Outpatient Urinary Tract Infections in an Era of Virtual Healthcare: Trends From 2008 to 2017. Clin Infect Dis. 2020 Jul 1; 71(1): 100–108. Published online 2019 Aug 22. doi: 10.1093/cid/ciz764. URL. Accessed on December 23, 2022.
  2. Ateev Mehrotra, MD; Suzanne Paone, DHA; G. Daniel Martich, MD. A comparison of care at e-visits and physician office visits for sinusitis and urinary tract infection. JAMA Intern Med. 2013;173(1):72-74. doi:10.1001/2013.jamainternmed.305. URL.
  3. Radhika Rastogi, Kathryn A. Martinez, Niyati Gupta, Mark Rood, and Michael B. Rothberg. Management of Urinary Tract Infections in Direct to Consumer Telemedicine. J Gen Intern Med. 2020 Mar; 35(3): 643–648. URL. Published online 2019 Oct 30. doi: 10.1007/s11606-019-05415-7.
  4. Collins L, Uzoaru F, Khasriya R. Clinical practice review on telehealth for managing a population with chronic urinary tract infections during the COVID-19 pandemic. Health Technology. Vol 6 (July 2022). URL.
  5. Murray MA, Penza KS, Myers JF, Furst JW, Pecina JL. Comparison of eVisit management of urinary symptoms and urinary tract infections with standard care. Telemed J E Health. 2020;26(5):639-644. doi:10.1089/tmj.2019.0044. URL.
  6. Pedrotti CHS, Accorsi TAD, De Amicis Lima K, et al. Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate. Int J Infect Dis. 2021;105:130-134. doi:10.1016/j.ijid.2021.02.020. URL.
Everlywell makes lab testing easy and convenient with at-home collection and digital results in days. Learn More