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Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data

Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data
Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data
Introduction: uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy.

Methods and analysis: a systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks.

Ethics and dissemination: the local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases.

PROSPERO registration number CRD42019125804.
adult urology, general medicine (see internal medicine), urinary tract infections
2044-6055
e035883
Heinz, Judith
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Röver, Christian
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Furaijat, Ghefar
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Kaußner, Yvonne
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Hummers-Pradier, Eva
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Debray, Thomas
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Hay, Alastair
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Heytens, Stefan
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Vik, Ingvild
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Little, Paul
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Moore, Michael
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Stuart, Beth
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Wagenlehner, Florian
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Kronenberg, Philipp Andreas
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Ferry, Sven
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Monsen, Tor
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Lindbæk, Morten
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Friede, Tim
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Gágyor, Ildikó
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Heinz, Judith
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Röver, Christian
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Furaijat, Ghefar
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Kaußner, Yvonne
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Hummers-Pradier, Eva
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Debray, Thomas
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Hay, Alastair
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Heytens, Stefan
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Vik, Ingvild
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Little, Paul
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Moore, Michael
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Stuart, Beth
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Wagenlehner, Florian
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Kronenberg, Philipp Andreas
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Ferry, Sven
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Monsen, Tor
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Lindbæk, Morten
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Friede, Tim
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Gágyor, Ildikó
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Heinz, Judith, Röver, Christian, Furaijat, Ghefar, Kaußner, Yvonne, Hummers-Pradier, Eva, Debray, Thomas, Hay, Alastair, Heytens, Stefan, Vik, Ingvild, Little, Paul, Moore, Michael, Stuart, Beth, Wagenlehner, Florian, Kronenberg, Philipp Andreas, Ferry, Sven, Monsen, Tor, Lindbæk, Morten, Friede, Tim and Gágyor, Ildikó (2020) Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data. BMJ Open, 10 (10), e035883. (doi:10.1136/bmjopen-2019-035883).

Record type: Article

Abstract

Introduction: uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy.

Methods and analysis: a systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks.

Ethics and dissemination: the local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases.

PROSPERO registration number CRD42019125804.

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Accepted/In Press date: 16 July 2020
Published date: 1 October 2020
Additional Information: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: adult urology, general medicine (see internal medicine), urinary tract infections

Identifiers

Local EPrints ID: 444315
URI: http://eprints.soton.ac.uk/id/eprint/444315
ISSN: 2044-6055
PURE UUID: 1523b522-1103-4db3-bf09-3317104956e8
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437

Catalogue record

Date deposited: 12 Oct 2020 16:31
Last modified: 10 Jan 2022 02:51

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Contributors

Author: Judith Heinz
Author: Christian Röver
Author: Ghefar Furaijat
Author: Yvonne Kaußner
Author: Eva Hummers-Pradier
Author: Thomas Debray
Author: Alastair Hay
Author: Stefan Heytens
Author: Ingvild Vik
Author: Paul Little
Author: Michael Moore ORCID iD
Author: Beth Stuart ORCID iD
Author: Florian Wagenlehner
Author: Philipp Andreas Kronenberg
Author: Sven Ferry
Author: Tor Monsen
Author: Morten Lindbæk
Author: Tim Friede
Author: Ildikó Gágyor

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