Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial
Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial
Background: randomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infection (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely include a 'no antibiotic' group.
Aim: to estimate the effect of antibiotic consumption, rather than prescription, on time to recovery in females with uncomplicated UTI.
Design and setting: secondary analysis of 14-day observational data from a point-of-care test trial for UTI in primary care in England, the Netherlands, Spain, and Wales, which ran from 2012 to 2014. Clinicians treated patients using their own judgement, providing immediate, delayed, or no antibiotic.
Method: UTI-symptomatic females who either consumed or did not consume antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤3 or >3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan-Meier and Cox proportional hazard models were employed to estimate time to recovery and hazard ratios, respectively.
Results: a total of n = 333 females who consumed antibiotics and n = 80 females who did not consume antibiotics were identified and included in the study. The adjusted median time to recovery was 2 days longer among patients who did not consume antibiotics (9 days, 95% confidence interval [CI] = 7 to 12) compared with those who did (7 days, 95% CI = 7 to 8). No difference was found between those who consumed ≤3 (7 days, 95% CI = 7 to 8) compared with >3 standardised antibiotic days (7 days, 95% CI = 6 to 9).
Conclusion: consuming antibiotics was associated with a reduction in self-reported time to recovery, but more antibiotics exposure was not associated with faster recovery in this study.
anti-bacterial agents, antibiotic consumption, general practice, recovery without antibiotics, uncomplicated, urinary tract infections
e882-e890
Gadalla, Amal
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Wise, Hannah
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Farewell, Daniel
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Hughes, Kathryn
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Llor, Carl
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Moore, Michael
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Verheij, Theo Jm
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Little, Paul
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Butler, Christopher C
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Francis, Nick A.
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24 November 2022
Gadalla, Amal
c940e535-777b-4382-8efd-2fa4570fe5bc
Wise, Hannah
0ef7722b-710c-40dc-821e-9550e0293663
Farewell, Daniel
bb0b8839-4fd9-418d-976f-f732002b2f8d
Hughes, Kathryn
e176d8ac-a6be-4c93-b7bb-e756362e0c90
Llor, Carl
a7fcfced-28f4-4771-8ca5-2c1ce2095d61
Moore, Michael
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Verheij, Theo Jm
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Little, Paul
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Butler, Christopher C
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Francis, Nick A.
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Gadalla, Amal, Wise, Hannah, Farewell, Daniel, Hughes, Kathryn, Llor, Carl, Moore, Michael, Verheij, Theo Jm, Little, Paul, Butler, Christopher C and Francis, Nick A.
(2022)
Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial.
The British journal of general practice : the journal of the Royal College of General Practitioners, 72 (725), .
(doi:10.3399/BJGP.2022.0011).
Abstract
Background: randomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infection (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely include a 'no antibiotic' group.
Aim: to estimate the effect of antibiotic consumption, rather than prescription, on time to recovery in females with uncomplicated UTI.
Design and setting: secondary analysis of 14-day observational data from a point-of-care test trial for UTI in primary care in England, the Netherlands, Spain, and Wales, which ran from 2012 to 2014. Clinicians treated patients using their own judgement, providing immediate, delayed, or no antibiotic.
Method: UTI-symptomatic females who either consumed or did not consume antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤3 or >3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan-Meier and Cox proportional hazard models were employed to estimate time to recovery and hazard ratios, respectively.
Results: a total of n = 333 females who consumed antibiotics and n = 80 females who did not consume antibiotics were identified and included in the study. The adjusted median time to recovery was 2 days longer among patients who did not consume antibiotics (9 days, 95% confidence interval [CI] = 7 to 12) compared with those who did (7 days, 95% CI = 7 to 8). No difference was found between those who consumed ≤3 (7 days, 95% CI = 7 to 8) compared with >3 standardised antibiotic days (7 days, 95% CI = 6 to 9).
Conclusion: consuming antibiotics was associated with a reduction in self-reported time to recovery, but more antibiotics exposure was not associated with faster recovery in this study.
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Published date: 24 November 2022
Additional Information:
Funding Information:
This research was partially supported by the Division of Population of Medicine, Cardiff University. The authors wish to thank Rhian Daniel, reader in Medical Statistics, Cardiff University for the very useful discussion and advice on statistical analysis.
Funding Information:
Nick A Francis reports grants from European Union FP7, during the conduct of the study; personal fees and non-financial support from Abbott and GSK, outside the submitted work. Carl Llor reports grants from Abbott Diagnostics, outside the submitted work. All other authors declare no competing interests.
Publisher Copyright:
© 2022 Royal College of General Practitioners. All rights reserved.
Keywords:
anti-bacterial agents, antibiotic consumption, general practice, recovery without antibiotics, uncomplicated, urinary tract infections
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Local EPrints ID: 473681
URI: http://eprints.soton.ac.uk/id/eprint/473681
ISSN: 0960-1643
PURE UUID: c5e0114c-e6c3-472d-a69c-1b27dae5e81c
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Date deposited: 27 Jan 2023 17:43
Last modified: 17 Mar 2024 03:58
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Author:
Amal Gadalla
Author:
Hannah Wise
Author:
Daniel Farewell
Author:
Kathryn Hughes
Author:
Carl Llor
Author:
Theo Jm Verheij
Author:
Christopher C Butler
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