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Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care - an individual patient data meta-analysis

Uncomplicated urinary tract infection (UTI) in women is common in general practice and is usually treated with antibiotics. Strategies to reduce antibiotic use were tested in seven randomized controlled trials (RCTs) including 2.849 patients with uncomplicated UTI by symptomatic treatment, placebo or delayed prescription but the overall effect of these strategies compared with immediate antibiotic treatment as standard care has not been analyzed. Furthermore, reducing antibiotics can prove difficult by uncertainty about which women would benefit from antibiotic treatment and which can be treated symptomatically effectively and safely. The aim of this project is 1) to estimate the effect of experimental strategies to reduce antibiotic use in women with uncomplicated UTI compared with immediate antibiotic treatment as standard care, 2) to identify moderators of treatment effects on symptoms comparing experimental strategies with immediate antibiotic treatment and 3) to identify prognostic factors at baseline associated with disease course of UTI in women allocated to experimental strategies and to develop a clinical prediction model to support treatment decisions in women with UTI. The primary outcome will be related to objective 1) and 2) incomplete clinical recovery, defined as persistent or worsening UTI symptoms, pyelonephritis or both at days 4-7. Secondary outcomes will be antibiotic use, clinical recovery at day 4, symptom burden at day 7, complications (pyelonephritis, febrile UTI), recurrent UTIs, adverse events within at least one month. Outcomes related to objective 3) will be a) women recovered without antibiotics and b) women subsequently treated with antibiotic after initial non-antimicrobial treatment. We will perform an individual patient data meta-analysis. If there is evidence that a prognostic model can differentiate mild from severe illness, it could help clinicians to identify women in whom symptomatic treatment can be used safely and effectively, as opposed to women who need antibiotics. We eventually aim to develop a clinical decision aid to predict the outcome of UTI to be used in consultations.

Project Details

FunderBundesministerium für Bildung und Forschung
Project CategoryDLR Project Management Agency
Project ReferenceKS2017-047
Funded PeriodSep 2017 - present
Funded ValueEUR 149,200
LeadProf. Tim Friede Friede - ORCID iD iconorcid.org/0000-0001-5347-7441
Dr. med. Ildikó Gágyor
Prof. Eva Hummers - ORCID iD iconorcid.org/0000-0003-2707-6067
Cooperating centers
  • Centre for Academic Primary Care, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol BS8 2PS UK (Prof. Alastair Hay)
  • Applied Health Research Centre (AHRC), St. Michael's Hospital, University of Toronto, Canada (Prof. Peter Jüni)
  • Institute of Health an Sociely, University of Oslo, Norway (Dr. Ingvild Vik, Prof Morten Lindbaek)
  • Academic Unit of primary care, University of Southampton, UK (Prof. Michael Moore/Prof. Paul Little)
  • Bacteriology, Umea University, Umea, Sweden (Prof. Sven Ferry, PhD)
  • Department of Clinical Pharmacology, Heymans Institute of Pharmacology Ghent University Belgium (Prof. Thierry Christiaens)
  • Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Thomas Debray, PhD)