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Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials

Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials
Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials
Objective: To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults.

Design: Systematic review andmeta-analysis of randomised trials.

Method: We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature(CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs.

Results: We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim?sulfamethoxazole after 1 month of prophylaxis.

Conclusions: Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.
2044-6055
Ahmed, Haroon
880dac61-6070-4e31-9d09-ed7dbbf9a5cf
Davies, Freya
663d21ac-3595-4f9a-97e6-553ad964dc3d
Francis, Nicholas
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Farewell, Daniel
bb0b8839-4fd9-418d-976f-f732002b2f8d
Butler, Christoper
d02c447d-38c0-41dc-bf1c-52c44a321120
Paranjothy, Shantini
04acae3d-1dba-48ee-80e4-6f4b85cb8043
Ahmed, Haroon
880dac61-6070-4e31-9d09-ed7dbbf9a5cf
Davies, Freya
663d21ac-3595-4f9a-97e6-553ad964dc3d
Francis, Nicholas
9b610883-605c-4fee-871d-defaa86ccf8e
Farewell, Daniel
bb0b8839-4fd9-418d-976f-f732002b2f8d
Butler, Christoper
d02c447d-38c0-41dc-bf1c-52c44a321120
Paranjothy, Shantini
04acae3d-1dba-48ee-80e4-6f4b85cb8043

Ahmed, Haroon, Davies, Freya, Francis, Nicholas, Farewell, Daniel, Butler, Christoper and Paranjothy, Shantini (2017) Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open, 7 (5), [e015233]. (doi:10.1136/bmjopen-2016-015233).

Record type: Article

Abstract

Objective: To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults.

Design: Systematic review andmeta-analysis of randomised trials.

Method: We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature(CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs.

Results: We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim?sulfamethoxazole after 1 month of prophylaxis.

Conclusions: Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.

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More information

Accepted/In Press date: 23 February 2017
e-pub ahead of print date: 29 May 2017
Published date: 29 May 2017

Identifiers

Local EPrints ID: 436139
URI: http://eprints.soton.ac.uk/id/eprint/436139
ISSN: 2044-6055
PURE UUID: 0b855616-1545-4c60-a24a-fce28848db18
ORCID for Nicholas Francis: ORCID iD orcid.org/0000-0001-8939-7312

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Date deposited: 29 Nov 2019 17:30
Last modified: 17 Dec 2019 01:20

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Contributors

Author: Haroon Ahmed
Author: Freya Davies
Author: Daniel Farewell
Author: Christoper Butler
Author: Shantini Paranjothy

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