Uncomplicated urinary tract infection in women is one of the most common reasons for presenting in ambulatory care and causes high rates of antibiotic prescription. Treatment approaches to reduce antibiotic use have been tested in several randomised controlled trials.
In the meta-analysis of individual patient data, we estimated the effect of the therapeutic strategies to reduce antibiotic consumption compared to an immediate antibiotic treatment. Furthermore, we aimed to identify moderators and prognostic factors of different courses of disease to facilitate treatment decisions for uncomplicated urinary tract infections in general practice.
Nine studies were included and analysed to compare different treatment strategies (analgesics, phytotherapeutics, delayed antibiotic prescriptions and placebo) with an immediate antibiotic treatment.
The study confirmed that an immediate treatment with antibiotics is effective in women with uncomplicated urinary tract infections. In particular, data showed that women without erythrocytes and bacterial growth in the urine can benefit from non-antibiotic strategies. Point-of-care tests to detect erythrocytes and bacteria in the urine at the time of treatment decision could therefore facilitate therapy with non-antibiotic strategies in line with antibiotic stewardship.
Within the framework of the project, the international symposium "Management of urinary tract infections in clinical practice: How to achieve the best use of evidence" was held in virtual format with almost 80 scientists from 10 European countries. In addition to the presentation of the project results, methodological challenges and solutions as well as new findings in diagnostics and therapy were presented and discussed by international experts in 10 further clinical and methodological contributions and two keynote lectures on the topic.
The project was funded by the German Federal Ministry of Education and Research (BMBF, grant number KS2017-047) and has been awarded with the David Sackett Prize of the Evidence-Based Medicine Network 2023.
Publication: Kaußner, Y.; Röver, C.; Heinz, J.; Hummers, E.; Debray, T. P. A.; Hay, A. D.; Heytens, S.; Vik, I.; Little, P.; Moore, M.; Stuart, B.; Wagenlehner, F.; Kronenberg, A.; Ferry, S.; Monsen, T.; Lindbæk, M.; Friede, T.; Gágyor, I. Reducing Antibiotic Use in Uncomplicated Urinary Tract Infections in Adult Women: A Systematic Review and Individual Participant Data Meta-Analysis. Clinical Microbiology and Infection 2022, S1198743X22003305. URL.
The project is an international cooperation of institutes of general practice in Germany (Würzburg, Göttingen), Belgium (Ghent), Great Britain (Southampton, Bristol), Norway (Oslo) as well as the Department of Medical Statistics (Göttingen, Germany) and the Department of Clinical Microbiology (Umea, Sweden), the Department of Clinical Pharmacology (Ghent, Belgium), Center for Health Sciences and Primary Care (Utrecht, Netherlands), Applied Health Research Centre (Toronto, Canada), and the Institute for Infectious Diseases (Bern, Switzerland).
National and international institutes of general practice and primary care
- University Hospital Würzburg (Institute of General Practice), Germany
- University Medical Center Göttingen (Department of General Practice/Family Medicine), Germany
- Ghent University (Department of Family Medicine and Primary Health Care), Belgium
- University of Southampton, Academic Unit of Primary Care, UK
- University of Southampton, Primary Care & Population Sciences, UK
- University of Bristol, Centre for Academic Primary Care, UK
- University of Oslo, Institute of Health and Society, Norway
- University Medical Centre Utrecht, Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Netherlands
- University of Toronto, Applied Health Research Centre (AHRC), St. Michael’s Hospital, Canada
National and international institutes of statistics, clinical pharmacology and microbiology
- University Medical Center Göttingen (Department of Medical Statistics), Germany
- Ghent University (Department of Clinical Pharmacology), Belgium
- Umea University, Department of Clinical Microbiology, Sweden
- University of Bern, Institute for Infectious Diseases, Switzerland