Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysisJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands.
Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, Bristol, United Kingdom.
Department of Public Health and Primary Care, University of Ghent, Belgium.
Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway.
Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, United Kingdom.
Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, United Kingdom.
Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, United Kingdom.
Clinic for Urology, Paediatric Urology and Andrology, Justus Liebig University Giessen, Germany.
Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Medical Statistics, University Medical Center, Goettingen, Germany.
Department of General Practice, University Medical Center, Wuerzburg, Germany; Department of General Practice, University Medical Center, Goettingen, Germany.
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2022 (English)In: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 28, no 12, p. 1558-1566Article, review/survey (Refereed) Published
Abstract [en]
Background: Randomised controlled trials (RCTs) investigated analgesics, herbal formulations, delayed prescription of antibiotics, and placebo to prevent overprescription of antibiotics in women with uncomplicated urinary tract infections (uUTI).
Objectives: To estimate the effect of these strategies and to identify symptoms, signs, or other factors that indicate a benefit from these strategies.
Data sources: MEDLINE, EMBASE, Web of Science, LILACS, Cochrane Database of Systematic Reviews and of Controlled Trials, and ClinicalTrials.
Study eligibility criteria, participants and interventions: RCTs investigating any strategies to reduce antibiotics vs. immediate antibiotics in adult women with uUTI in primary care.
Methods: We extracted individual participant data (IPD) if available, otherwise aggregate data (AD). Bayesian random-effects meta-analysis of the AD was used for pairwise comparisons. Candidate moderators and prognostic indicators of treatment effects were investigated using generalised linear mixed models based on IPD.
Results: We analysed IPD of 3524 patients from eight RCTs and AD of 78 patients. Non-antibiotic strategies increased the rates of incomplete recovery (OR 3.0; 95% credible interval (CrI), 1.7–5.5; Bayesian p-value (pB) = 0.0017; τ = 0.6), subsequent antibiotic treatment (OR 3.5; 95% CrI, 2.1–5.8; pB = 0.0003) and pyelonephritis (OR 5.6; 95% CrI, 2.3–13.9; pB = 0.0003). Conversely, they decreased overall antibiotic use by 63%.
Patients positive for urinary erythrocytes and urine culture were at increased risk for incomplete recovery (OR 4.7; 95% CrI, 2.1–10.8; pB = 0.0010), but no difference was apparent where both were negative (OR 0.8; 95% CrI, 0.3–2.0; pB = 0.667). In patients treated using non-antibiotic strategies, urinary erythrocytes and positive urine culture were independent prognostic indicators for subsequent antibiotic treatment and pyelonephritis.
Conclusions: Compared to immediate antibiotics, non-antibiotic strategies reduce overall antibiotic use but result in poorer clinical outcomes. The presence of erythrocytes and tests to confirm bacteria in urine could be used to target antibiotic prescribing.
Place, publisher, year, edition, pages
Elsevier , 2022. Vol. 28, no 12, p. 1558-1566
Keywords [en]
Analgesics, Antibiotics, Cystitis, Delayed prescription, Erythrocytes, General practice
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:umu:diva-203319DOI: 10.1016/j.cmi.2022.06.017ISI: 000922899400008PubMedID: 35788049Scopus ID: 2-s2.0-85132741221OAI: oai:DiVA.org:umu-203319DiVA, id: diva2:1728322
2023-01-182023-01-182023-09-05Bibliographically approved