• LOGIN
Repository logo

BORIS Portal

Bern Open Repository and Information System

  • Publication
  • Projects
  • Funding
  • Research Data
  • Organizations
  • Researchers
  • LOGIN
Repository logo
Unibern.ch
  1. Home
  2. Publications
  3. Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis.
 

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

Options
  • Details
BORIS DOI
10.48350/171117
Date of Publication
December 2022
Publication Type
Article
Division/Institute

Institut für Infektio...

Author
Kaußner, Yvonne
Röver, Christian
Heinz, Judith
Hummers, Eva
Debray, Thomas P A
Hay, Alastair D
Heytens, Stefan
Vik, Ingvild
Little, Paul
Moore, Michael
Stuart, Beth
Wagenlehner, Florian
Kronenberg, Andreas Oskarorcid-logo
Institut für Infektionskrankheiten (IFIK)
Ferry, Sven
Monsen, Tor
Lindbæk, Morten
Friede, Tim
Gágyor, Ildikó
Subject(s)

500 - Science::570 - ...

600 - Technology::610...

Series
Clinical microbiology and infection
ISSN or ISBN (if monograph)
1469-0691
Publisher
Elsevier
Language
English
Publisher DOI
10.1016/j.cmi.2022.06.017
PubMed ID
35788049
Uncontrolled Keywords

Analgesics Antibiotic...

Description
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 versus immediate antibiotics in adult women with uUTI in primary care.

DATA SYNTHESIS

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 (odds ratio [OR] 3.0; 95% credible interval [CI] 1.7-5.5; Bayesian p-value pB=0.0017; τ=0.6), subsequent antibiotic treatment (OR 3.5 [95% CI 2.1, 5.8; pB=0.0003) and pyelonephritis (OR 5.6; 95% CI 2.3, 13.9; pB=0.0003). Conversely, they decreased overall antibiotic use by 63%. In patients positive for urinary erythrocytes and urine culture were at increased risk for incomplete recovery (OR 4.7; 95% CI 2.1-10.8; pB =0.0010), but no difference was apparent where both were negative (OR 0.8; 95% CI 0.3-2.0; pB =0.667). In patients treated with using non-antibiotic strategies, urinary erythrocytes and positive urine culture were independent prognostic indicators for subsequent antibiotic treatment and pyelonephritis.

CONCLUSIONS AND RELEVANCE

Compared to immediate antibiotics, non-antibiotic strategies reduce overall antibiotic use but result in poorer clinical outcomes. The presence of erythrocytes and tests to confirm bacteria in urine could be used to target antibiotic prescribing.
Handle
https://boris-portal.unibe.ch/handle/20.500.12422/85993
Show full item
File(s)
FileFile TypeFormatSizeLicensePublisher/Copright statementContent
1-s2.0-S1198743X22003305-main.pdftextAdobe PDF1.24 MBacceptedOpen
BORIS Portal
Bern Open Repository and Information System
Build: d1c7f7 [27.06. 13:56]
Explore
  • Projects
  • Funding
  • Publications
  • Research Data
  • Organizations
  • Researchers
More
  • About BORIS Portal
  • Send Feedback
  • Cookie settings
  • Service Policy
Follow us on
  • Mastodon
  • YouTube
  • LinkedIn
UniBe logo