Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis

Abstract

Recurrent urinary tract infections (RUTI) are a common health problem. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis. We conducted a systematic review and meta-analysis of RCTs published up to 13 October 2020, evaluating patients ≥ 12 years with either ≥2 episodes of lower UTI within 6 months, or ≥ 3 in the past year. Placebo or antibiotics were allowed as comparators. Study quality was low. In the 11 placebo-controlled trials the risk for developing UTI was 85% lower with prophylaxis in comparison to placebo (RR 0.15, 95% CI 0.08-0.29). In the 9 head-to-head trials efficacy of antibiotic agents appeared similar: The pooled RR indicated no difference between nitrofurantoin and comparators [RR 1.01 (0.74-1.37)], nor trimethoprim (+/- sulfamethoxazole) [RR 1.34 (0.89-2.03)] or norfloxacin and comparators [RR 1.17 (0.43-1.70)]. Studies comparing intermittent (post-coital) to continuous strategies revealed intermittent application as equally effective.

Safety and efficacy of nightly nitrofurantoin as prophylaxis in dogs with recurrent urinary tract infections: 13 cases (2015‐2021)

“…No optimal therapeutic or monitoring protocol exists in humans (Epp & Larochelle 2010, Price et al 2016. Since the current emphasis in human and veterinary medicine is treatment and prevention of clinical recurrence rather than microbial recurrence (Weese et al 2019, Jent et al 2022, monitoring protocols focused on clinical signs might be more critical than urine cultures. Monitoring for adverse events, such as hepatotoxicity, was also inconsistent and at clinician discretion.…”

“…In human urology, continuous antimicrobial prophylaxis is a standard approach to reduce the risk of urinary tract infection (UTI) in patients, primarily women, with rUTIs (Albert et al 2004, Epp & Larochelle 2010, Jent et al 2022. Goals of therapy include reduced morbidity and decreased economic burden (Albert et al 2004, Epp & Larochelle 2010.…”

“…Protocols describe multiple different antibiotics, including nitrofurantoin at 50 to 100 mg/day daily or 50 mg twice daily (Muller et al 2017). No optimal therapeutic or monitoring protocol has been definitively proven (Epp & Larochelle 2010, Price et al 2016, Muller et al 2017, Jent et al 2022. Efficacy is primarily assessed based on reduction in clinical recurrence rate, with lower priority given to microbial recurrence (Jent et al 2022).…”

“…No optimal therapeutic or monitoring protocol has been definitively proven (Epp & Larochelle 2010, Price et al 2016, Muller et al 2017, Jent et al 2022. Efficacy is primarily assessed based on reduction in clinical recurrence rate, with lower priority given to microbial recurrence (Jent et al 2022). Despite its standard use in human medicine, prophylactic antimicrobial therapy is not currently recommended in veterinary medicine for dogs with rUTIs due to an absence of data, concerns for adverse drug effects, selection for bacterial resistance, and concern for the potential of high recurrence rates after discontinuation of medication (Weese et al 2019).…”

Current understanding of genetic associations with delayed hypersensitivity reactions induced by antibiotics and anti-osteoporotic drugs

“…Co-trimoxazole is an antibiotics indicated for urinary tract infection and Pneumocystis jiroveci pneumonia ( Haseeb et al, 2022 ; Jent et al, 2022 ). The prevalence of skin adverse reaction was 1%–4% among general population treated with co-trimoxazole ( Wolkenstein et al, 1995 ; Masters et al, 2003 ).…”