{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T22:37:57Z","timestamp":1775947077784,"version":"3.50.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T00:00:00Z","timestamp":1675296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Everly Health, Inc."},{"name":"Everly Health, Inc."},{"name":"Everly Health, Inc."},{"name":"Everly Health, Inc."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Telemedicine programs for the treatment of urinary tract infections (UTIs) offer an opportunity to reduce burdens on patients and providers. However, these programs are typically restricted to patients with uncomplicated UTIs. This real-world analysis evaluated treatment and resolution rates in a large-scale, national UTI telemedicine program inclusive of patients with uncomplicated and complicated UTIs. We conducted a retrospective analysis of data obtained from a commercially available telemedicine program for the treatment of UTIs among adult women in the US between 2017 and 2021 (n = 51,474). The primary outcomes were the number of women who presented with symptoms of uncomplicated UTI, complicated UTI, and vaginal infection; prescription use and antibiotic type; symptom resolution within seven days after appointment; and treatment failure or relapse. Most patients reported frequent urination (94.4%), urgency (94.5%), and dysuria (97.6%). Those with uncomplicated UTI symptoms represented the majority of patients (61.6%); however, a substantial number of patients (36.5%) also reported at least one symptom associated with a complicated UTI. One-fifth of patients (19.2%) reported at least one co-occurring symptom of vaginal infection or sexually transmitted infection. Across all treated patients, 94.0% received recommended antibiotics according to the clinical protocol. Of the treated patients who provided follow-up data (n = 3,521), 89.7% reported seven-day symptom resolution. Symptom resolution rates were similar between patients with uncomplicated UTI symptoms (90.8%) and complicated UTI symptoms (87.9%), and symptom resolution among all treated patients (89.7%) was similar to reports for in-person standard of care. These findings suggest that large-scale telemedicine programs for the treatment of UTIs can be effective in the treatment of complicated UTIs.<\/jats:p>","DOI":"10.1371\/journal.pone.0280386","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T13:35:49Z","timestamp":1675344949000},"page":"e0280386","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Real-world evidence: Telemedicine for complicated cases of urinary tract infection"],"prefix":"10.1371","volume":"18","author":[{"given":"Natalie M.","family":"Daumeyer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Kreitzberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen M.","family":"Gavin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0334-3215","authenticated-orcid":true,"given":"Timothy A.","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,2,2]]},"reference":[{"issue":"169","key":"pone.0280386.ref001","first-page":"1","article-title":"Ambulatory medical care utilization estimates for 2007","author":"SM Schappert","year":"2011","journal-title":"Vital Health Stat 13"},{"issue":"2","key":"pone.0280386.ref002","doi-asserted-by":"crossref","first-page":"209","DOI":"10.5811\/westjem.2019.10.43497","article-title":"Changes in emergency department care intensity from 2007\u201316: analysis of the National Hospital Ambulatory Medical Care survey","volume":"21","author":"SC Chou","year":"2020","journal-title":"West J Emerg Med"},{"issue":"10","key":"pone.0280386.ref003","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1111\/j.1553-2712.2011.01167.x","article-title":"A randomized trial of computer kiosk-expedited management of cystitis in the emergency department","volume":"18","author":"JC Stein","year":"2011","journal-title":"Acad Emerg Med"},{"key":"pone.0280386.ref004","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1146\/annurev.publhealth.21.1.613","article-title":"Telemedicine: a new health care delivery system","volume":"21","author":"RL Bashshur","year":"2000","journal-title":"Annu Rev Public Health"},{"key":"pone.0280386.ref005","volume-title":"StatPearls","author":"MJ Bono","year":"2022"},{"issue":"6","key":"pone.0280386.ref006","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1086\/511866","article-title":"Adherence to the Infectious Diseases Society of America guidelines in the treatment of uncomplicated urinary tract infection","volume":"44","author":"Y Taur","year":"2007","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0280386.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.idc.2013.09.003","article-title":"Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden","volume":"28","author":"B. 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Complicated urinary tract infections: developing drugs for treatment. Guidance for industry. 2018. https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/complicated-urinary-tract-infections-developing-drugs-treatment. 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