Which treatment strategy for women with symptoms of urinary tract infection?

Bjerrum, Lars; Lindbæk, Morten

doi:10.1136/bmj.h6888

Cited by 6 publications

(3 citation statements)

References 11 publications

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“… 10 , 32 The present results may help informing such a shared decision-making approach if patients were aware of the likelihood of recovering within 14 days without antibiotics. These strategies are particularly useful in younger patients and in those with lower risk for pyelonephritis 10 , 31 , 33 and could lead to a reduction in antibiotic use and risk of resistance. 26 Attention should focus on trying to identify these females, particularly as it is possible that some of them do not have bacterial infections (only 34% of the study group had culture-confirmed bacterial pathogen), or that their immunity are able to self-limit the infection.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial

Gadalla¹,

Wise²,

Farewell³

et al. 2022

Br J Gen Pract

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Background: Randomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infections (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely included a 'no antibiotic' group. Aim: To estimate the effect of antibiotic consumption, rather than prescription, on time-to-recovery in women with uncomplicated UTI. Design and Settings: Secondary analysis of 14-day observational data from a trial of a point of care test for UTI in primary care. Clinicians treated patients using their own judgment providing immediate, delayed, or no antibiotics. Methods: UTI-symptomatic women who either consumed (n= 333) or did not consume (n= 80) antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤ 3 or > 3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan-Meier and Cox proportional hazard models were employed to estimate time-to-recovery and hazard ratios, respectively. Findings: The adjusted median time-to-recovery was 2 days longer among patients who did not consume antibiotics (9 days; 95% CI 7–12) compared to those who did (7 days; 95% CI 7–8). We found no difference between those who consumed ≤ 3 (7 days; 95% CI 7–8) compared to > 3 standardised antibiotic days (7 days; 95% CI 6 – 9). Conclusions: Consuming antibiotics was associated with a reduction in self-reported time-to-recovery, but more antibiotics exposure was not associated with faster recovery in this study.

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Section: Discussionmentioning

confidence: 99%

Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial

Gadalla¹,

Wise²,

Farewell³

et al. 2022

Br J Gen Pract

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“…If patients were aware of the likelihood of reaching recovery by day 14 without antibiotics, some may choose to refrain from immediate antibiotics, which supports delayed antibiotic strategies. This may be particularly useful in younger patients and in those with lower risk for pyelonephritis (8,21,22) and could lead to a reduction in antibiotic use and risk of antibiotic resistance as evident in respiratory tract infections. ( 23) Propensity score: the probability of antibiotic consumption given the severity score of the initial symptoms and the history of previous UTI treatment.…”

Section: Implications For Research And/or Practicementioning

confidence: 99%

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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“…If the symptom-experience when having a UTI differs with menopausal status, this may affect the diagnostic value of symptoms and signs in clinical practice, as well as the relevance of individual symptoms. Further, this difference in the diagnostic value of symptoms may lead to some women being misdiagnosed and either under-or overtreated with antibiotics [18].…”

Section: Introductionmentioning

confidence: 99%

Severity and Bothersomeness of Urinary Tract Infection Symptoms in Women before and after Menopause

Teglbrænder-Bjergkvist,

Siersma,

Holm

2023

Antibiotics

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Urinary tract infection (UTI) is a common cause for prescription of antibiotics among women in general practice. Diagnosis is often established by inquiry into clinical history and symptoms, and these may be experienced differently depending on menopause status of the woman. The aim of this study was to assess differences in severity and bothersomeness of UTI symptoms between pre- and postmenopausal women. We used a convenience sample of 313 women with suspected UTIs and typical symptoms recruited in general practice. Each woman completed the Holm and Cordoba UTI score (HCUTI), measuring the severity and bothersomeness of the dimensions: dysuria, frequency, lower back, and general symptoms. The exposure was menopausal status. Differences in the various HCUTI dimensions between the menopause groups were investigated in linear regression models, adjusting for potential confounders. Premenopausal women had a significantly higher severity score for the item “feeling unwell” than postmenopausal women (mean difference −0.59, 95% CI −0.88 to −0.31). They also had a significantly higher bothersomeness score for the items “pain on urination” (mean difference −0.54, 95% CI −0.83 to −0.25), “feeling unwell” (mean difference −0.62, 95% CI −0.92 to −0.32), and for the dimension “dysuria” (mean difference −0.38, 95% CI −0.61 to −0.15) than postmenopausal women. This study found differences in some aspects of symptom severity and bothersomeness between pre- and postmenopausal women presenting in general practice with suspected UTIs. Menopausal status should be taken into account when using symptoms to diagnose and evaluate response to UTI treatment in both clinical practice and research.

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Which treatment strategy for women with symptoms of urinary tract infection?

Abstract: Many women could avoid antibiotics

Cited by 6 publications

References 11 publications

Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial

Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial

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

Severity and Bothersomeness of Urinary Tract Infection Symptoms in Women before and after Menopause

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