Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review

Hoffmann, Tammy; Peiris, Ruwani; Mar, Chris Del; Cleo, Gina; Glasziou, Paul

doi:10.3399/bjgp20x712781

Cited by 22 publications

(25 citation statements)

References 15 publications

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“… 10 11 Thus, the lower yield of urine cultures in this study may be due to spontaneous resolution of infection because of the delays in accessing healthcare or self-treatment with antibiotics. 15 This may particularly be the case in patients with leucocyturia where symptoms can be explained by residual inflammation. Dysuria and leucocyturia in the absence of positive urine cultures may be due to other causes such as urogenital tuberculosis, schistosomiasis and other inflammatory conditions.…”

Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

et al. 2021

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ObjectiveUrinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.DesignCross-sectional study.SettingNine primary health clinics in Harare, Zimbabwe.ParticipantsAdults presenting with symptoms of UTIs between March and July 2020.Primary outcome measuresUrine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.ResultsThe study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen. Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.ConclusionsThis study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.

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Section: Discussionmentioning

confidence: 99%

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

et al. 2021

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“…In line with other studies symptom resolution or improvement was common even in those participants who did not take effective treatment. Spontaneous symptom resolution of uncomplicated cystitis occurs in about a third of patients 9 . However, patients without spontaneous cure often experience debilitating symptoms that can persist for several weeks 10 , affecting quality of life 11 and leading to economic costs due to loss of income, missed days at work and medical expenses 1,12,13 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and bacteriological outcomes in patients with urinary tract infections presenting to primary care in Harare, Zimbabwe: a cohort study

Olaru¹,

Chisenga²,

Yeung³

et al. 2022

Wellcome Open Res

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Background: Treatment for urinary tract infections (UTIs) is usually empiric and is based on local antimicrobial resistance data. These data, however, are scarce in low-resource settings. The aim of this study is to determine the impact of antibiotic treatment on clinical and bacteriological outcomes in patients presenting with UTI symptoms to primary care in Harare. Methods: This cohort study enrolled participants presenting with UTI symptoms to 10 primary healthcare clinics in Harare between July 2019 and July 2020. A questionnaire was administered and a urine sample was collected for culture. If the urine culture showed growth of ≥105 colony forming units/mL of a uropathogen, a follow up visit at 7-21 days was conducted. Results: The analysis included 168 participants with a median age of 33.6 years (IQR 25.1-51.4) and of whom 131/168 (78.0%) were female. Effective treatment was taken by 54/168 (32.1%) participants. The urine culture was negative at follow up in 41/54 (75.9%) of participants who took appropriate treatment and in 33/114 (28.9%, p<0.001) of those who did not. Symptoms had improved or resolved in 52/54 (96.3%) of those on appropriate treatment and in 71/114 (62.3%, p<0.001) of those without. Conclusion: The findings of this study show that effective treatment leads to symptom resolution and bacterial clearance in people presenting with UTIs to primary care. Although UTIs are not life-threatening and can resolve without treatment, they do impact on quality of life, highlighting the need for optimised treatment recommendations.

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“…Hoffmann et al reviewed the natural course of uncomplicated UTI in women on studies up to November 2019, they found only three placebo-controlled randomized trials and reported symptoms duration. (19) Their results showed that complete symptom recovery could occur in 18% (up to 3 days) to 54% (up to 6 weeks) of the placebo arm, with most improvement occurring in the first 9 days. These findings are in line with our results as we found symptoms were completely resolved within the study follow up in nearly two thirds (62%) of the women who did not consume antibiotics.…”

Section: Comparison With Existing Literaturementioning

confidence: 98%

Effect of antibiotic consumption on self-reported recovery from uncomplicated urinary tract infection

Gadalla

Wise

Hughes

et al. 2021

Preprint

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Background Randomised trials provide high-quality data on the effects of antibiotics for urinary tract infections (UTI) but are prone to selection bias and may not accurately reflect effects in those who actually consume antibiotics. Aim To estimate the effect of antibiotic consumption, rather than prescription, on self-reported time to recovery in women with uncomplicated UTI. Design and setting Secondary analysis of data from a randomised control trial on point of care diagnostic to guide antibiotic prescribing in primary care. Antibiotic prescribing decisions were not mandated by the trial protocol. Methods 413 adult women presenting with UTI symptoms and who either consumed (n=333) or did not consume (n=80) one or more doses of antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised using defined daily dose (DDD) and described as days-worth of antibiotics. Cox-proportional hazard model was used to estimate the effect of antibiotic consumption upon time to self-reported recovery, controlling for potential confounders and propensity of consuming antibiotics based on baseline symptom severity and history of UTI treatment. Results The crude median time to recovery was 3 days longer among patients who did not consume antibiotics (10 days; 95% CI= 8.5-11.5) compared to those who consumed antibiotics (7 days; 95% CI= 6.5-7.5). Patients who consumed >0 to <3, ≥3 to ≤5, and >5 days-worth of antibiotics recovered at approximately 2 to 3 times faster than the rate of those who consumed no antibiotics, adjusted HR 3.2 (95% CI 2.0, 5.1), 2.8 (1.8, 4.3), 2.3 (1.5, 3.7), respectively. Conclusion Consuming antibiotics was associated with a reduction in self-reported time to recovery in this study which is consistent with results from previous trials.

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Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review

Cited by 22 publications

References 15 publications

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study

Clinical and bacteriological outcomes in patients with urinary tract infections presenting to primary care in Harare, Zimbabwe: a cohort study

Effect of antibiotic consumption on self-reported recovery from uncomplicated urinary tract infection

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