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

Tim Friede Friede, Ildikó Gágyor, Eva Hummers

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.

 

Bundesministerium für Bildung und Forschung

Source of Funding

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