Journal article

Publication year: 2022

Pages: 1558-1566

Journal: Clinical Microbiology and Infection

Volume number: 28

Issue number: 12

ISSN: 1198-743X

eISSN: 1469-0691

Open access status: Hybrid

DOI Link: https://doi.org/10.1016/j.cmi.2022.06.017

Publisher: Elsevier

Abstract: 
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), 1.7e5.5; Bayesian pvalue (pB) 1/4 0.0017; t 1/4 0.6), subsequent antibiotic treatment (OR 3.5; 95% CrI, 2.1e5.8; pB 1/4 0.0003) and pyelonephritis (OR 5.6; 95% CrI, 2.3e13.9; pB 1/4 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, 2.1e10.8; pB 1/4 0.0010), but no difference was apparent where both were negative (OR 0.8; 95% CrI, 0.3e2.0; pB 1/4 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.

Harvard Citation style: Kaussner, Y., Roever, C., Heinz, J., Hummers, E., Debray, T., Hay, A., et al. (2022) Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis, Clinical Microbiology and Infection, 28(12), pp. 1558-1566. https://doi.org/10.1016/j.cmi.2022.06.017

APA Citation style: Kaussner, Y., Roever, C., Heinz, J., Hummers, E., Debray, T., Hay, A., Heytens, S., Vik, I., Little, P., Moore, M., Stuart, B., Wagenlehner, F., Kronenberg, A., Ferry, S., Monsen, T., Lindbaek, M., Friede, T., & Gagyor, I. (2022). Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis. Clinical Microbiology and Infection. 28(12), 1558-1566. https://doi.org/10.1016/j.cmi.2022.06.017