Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

Abstract

ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI).Setting16 sites in a primary care setting in Norway, Sweden and Denmark.ParticipantsData from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.MethodsUsing the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.ResultsOf the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).ConclusionWe did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.Trial registration numberClinicalTrials.gov (NCT01849926).

The Risk of Pyelonephritis Following Uncomplicated Cystitis: A Nationwide Primary Healthcare Study

“…Nevertheless, in waiting for such data, we suggest, based on previous evidence [ 8 , 9 , 10 , 14 , 15 , 16 ] together with our findings, that otherwise healthy women with mild symptoms can be advised to manage without antibiotics. On the other hand, if, for example, the woman is severely bothered by her symptoms and has a positive urine dipstick [ 7 , 30 ], first-line antibiotic treatment for cystitis with low rates of resistance in the community [ 5 ] could be prescribed, perhaps with a recommendation to wait and see in a shared decision-making process [ 2 ].…”

“…The incidence rates are about 20-fold lower [ 3 , 4 ] and with similar sociodemographic differences [ 4 ]. However, while pyelonephritis requires antibiotic therapy [ 3 , 5 , 6 ], cystitis might not [ 2 , 7 , 8 ].…”