Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data

Abstract

IntroductionUncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy.Methods and analysisA systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks.Ethics and disseminationThe local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases.PROSPERO registration numberCRD42019125804.

Antimicrobial Resistance Among Uropathogens: Surveillance Report From South India

“…Urinary Tract Infection (UTI) is one of the most common infections encountered in clinical practice. Empirical treatment for both complicated and uncomplicated UTI has been practiced throughout the world because a failure in timely treatment might lead to increased morbidity and mortality [ 1 , 2 , 3 ]. Empirical treatment could be a failure if the local resistance rates of the uropathogens for the used antibiotic exceed 20 % [ 1 , 4 ].…”

Herbal treatment with uva ursi extract versus fosfomycin in women with uncomplicated urinary tract infection in primary care: a randomized controlled trial

“…The highest reduction rates were observed in a trial with a herbal drug (BNO 1045), where 83.5% of the patients in the intervention group did not take antibiotics during the 38-day follow-up period [26]. A meta-analysis comparing these trials is in progress aiming to identify who may benefit from alternative approaches to reduce antibiotic use and those susceptible to adverse outcomes [27].…”

Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis

“…We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement). 17 The protocol was published 18 and registered with Prospero (CRD42019125804). The study was evaluated by the ethics review board of the University of Wuerzburg in August 2019 (ID 20129072301) No ethical objections were raised.…”

“…Our search strategy addressed eligible RCTs using search terms including relevant medical subject headings and keywords such as urinary tract infection OR urinary tract infections OR UTI OR bacteriuria OR pyuria OR cystitis OR pyelonephritis) AND (antibiotic OR antibiotics OR anti-bacterial agents OR antimicrobial). 18 The full search strategies are included in Supplement 4.…”

“…Two review authors (IG, TF) invited the authors of eligible studies to provide the IPD electronically via standardised anonymized data extraction sheets. 18 Data transfers were performed via secured servers in compliance with relevant data protection regulations. 19 If IPD were not available, we analysed the aggregated data (AD).…”