Which women treated first symptomatically for a urinary tract infection (UTI) are later prescribed an antibiotic?

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
3A.4

The problem

UTI is a common, potentially self-limiting condition in general practice. In a recently completed randomised-controlled trial (ICUTI - Immediate versus conditional treatment for UTI) we showed that an initial symptomatic treatment of UTI with ibuprofen (and antibiotics only if needed) can reduce the number of antibiotic courses. The approach: The aim of this sub-group analysis was to identify the determinants for a self-limiting course of UTI, i.e. for recovering without antibiotic treatment in the ibuprofen group of the ICUTI trial. In ICUTI, 494 women with uncomplicated UTI between 18 and 65 years were randomised to receive either ibuprofen 3x 400mg for three days and antibiotics only if needed or immediate antibiotic treatment with fosfomycin-trometamol 1x3 g. To assess the use of antibiotic prescriptions and symptom relief, follow-up calls were conducted until day 28. To determine factors associated with recovery without antibiotics, the baseline data of women in the ibuprofen group with and without secondary antibiotic treatment have been analysed using multiple logistic regression analysis. Odds ratios (ORs) and their 95% confidence intervals (CI) will be calculated as measures of effect size. Findings: Of 241 women in the ibuprofen group 85 (35%) needed antibiotic prescriptions within 28 days of study period. Of these 75 (31%) were UTI-related, 156 women had a self-limiting course of UTI. The preliminary results show that women recovering without antibiotics were slightly younger (36.3 years; SD ±14.4 vs. 39.3; ±15), and more of them had recurrent UTI previously (18.7% vs. 14.7%). The number of positive urine cultures was significantly higher in those who needed antibiotics compared with those with a self-limiting course of UTI (93.3% vs. 67.7%; p<0.001). A more detailed analysis will be presented at the SAPC conference. Consequences: Findings of this analysis may be helpful for both general practitioners and affected women to discuss whether to treat UTI symptomatically with ibuprofen or with antibiotics. We intend to use this as the basis for developing a decision aid which will require further validation.

Credits

  • Ildiko Gagyor, Institute of General Practice, Hannover Medical School, Hannover, Germany
  • Jutta Bleidorn, Institute for Public Health and Nursing Research, Department for Health Services Research, University of Bremen, Bremen, Germany
  • Guido Schmiemann, Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
  • Karl Wegscheider
  • Eva Hummers-Pradier, Institute of General Practice, Hannover Medical School, Hannover, Germany
  • Wolfgang Himmel, Institute of General Practice, Hannover Medical School, Hannover, Germany