The most common uropathogens isolated in urinary culture were E. coli, 233 patients (49%), Klebsiella pneumoniae, 102 patients (21%), and Enterococcus faecalis, 44 patients (9.2%) (Table 1). Urinary tract infections are frequent causes of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits especially in certain high-risk groups [6,7,8,9]. Urinary tract infection and recurrent UTI are common problems in outpatients visits especially in postmenopausal women. Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Bookshelf Vitamin D deficiency as a risk factor for urinary tract infection in women at reproductive age. Terms of Use| and transmitted securely. . An official website of the United States government. https://doi.org/10.1002/14651858.CD001209.pub2. Before 2010;340:c346. 2010 Jul;36(4):846-51. doi: 10.1093/schbul/sbn191. Martnez MA, Inglada L, Ochoa C. Villagrasa, Assessment of antibiotic prescription in acute urinary tract infections in adults. Medical management of vesicoureteral reflux--quiz within the article. 1992;24(1):3-10. doi: 10.1007/BF02552109. The Bucherer-Bergs Multicomponent Synthesis of Hydantoins-Excellence in Simplicity. Ther Adv Urol. Al-Rubeaan KA, Moharram O, Al-Naqeb D, Hassan A, Rafiullah MR. Primsol may cause anemia due to a deficiency of folic acid. All meta-analyses were performed using the statistical package OpenMetaAnalyst utilizing the meta and metafor packages in R (R Foundation for Statistical Computing, Vienna, Austria), based on random- and fixed-effects models. The most common side effects associated with Primsol involve the Recurrent urinary tract infections (UTIs) are defined as two episodes of acute bacterial cystitis, along with associated symptoms within the last six months or three episodes within the last year. Ann Intern Med. pregnant women. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. official website and that any information you provide is encrypted Similarly, there was no difference between norfloxacin and its comparators (3 studies; RR, 1.17; 95% CI, 0.431.70). 2022. Recurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. In the 11 placebo-controlled trials, the risk for developing UTI was 85% lower with prophylaxis in comparison with placebo (risk ratio [RR], 0.15; 95% CI, 0.080.29). Nitrofurantoin was more frequently used in this patient population (64.3% vs 35.7%). When reviewing the inclusion criteria, it is noteworthy that no uniform RUTI definition was employed in the included studies. Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. As microbial recurrences nowadays are considered to be of minor relevance, a subanalysis restricted to reported clinical recurrences in placebo-controlled studies was performed (Figure3). 1988 Jan;2(1):12-7. doi: 10.1007/BF00870372. Only half of patients with recurrent UTI were prescribed prophylaxis antibiotics. Unauthorized use of these marks is strictly prohibited. Epub 2016 Jul 22. Over the years, the definition of RUTI has changed from requiring 2 UTIs in the past 12 months (in earlier studies) to 3 or more UTIs within 1 year (in later studies). The site is secure. Studies comparing intermittent (postcoital) with continuous strategies revealed intermittent application to be equally effective. Molecules. RUTIs are a common problem, causing morbidity and health care costs. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; antibiotic prophylaxis, recurrent urinary tract infection, meta-analysis, UTI, cystitis. Recurrent urinary tract infection, defined as the occurrence of three episodes of UTIs in 12months or two episodes in 6months incidence may be as high as 44% [6, 9, 10, 14]. The children received the antibiotics for 6 months. aIncluding overlap between studies with a placebo as well as an antibiotic comparator. Therefore, the physician must weigh the potential risks to the fetus against the Spencer JD, Schwaderer A, McHugh K, Hains DS. Vasudeva P, Madersbacher H. Factors implicated in pathogenesis of urinary tract infections in neurogenic bladders: some revered, few forgotten, others ignored. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. Durations of prophylaxis >12 months have not been studied in a controlled setting, although 1 case series reported sustained efficacy over 5 years [46]. TMP-SMX was prescribed significantly more for recurrent UTI occurring in the pre-menopausal period. Article The categorical variables were compared using a chi-square test or Fishers exact test, as appropriate. Adv Data. Harding et al. See additional information. Efficacy of five years of continuous, low-dose trimethoprim-sulfamethoxazole prophylaxis for urinary tract infection, Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women, Prevention of recurrent acute uncomplicated cystitis by increasing daily water in premenopausal women: a prospective, randomized, controlled study. Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study. College of Medicine, King Saud Ibn Abdulaziz University for Health and Sciences, Riyadh, Saudi Arabia, Hala Alghoraibi,Aisha Asidan,Raneem Aljawaied,Raghad Almukhayzim,Aljoharah Alsaydan&Elaf Alamer, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia, Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia, Hala Alghoraibi,Aisha Asidan,Raneem Aljawaied,Raghad Almukhayzim,Aljoharah Alsaydan,Elaf Alamer,Waleed Baharoon&Salim Baharoon, King Saud Bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia, Hala Alghoraibi,Aisha Asidan,Raneem Aljawaied,Raghad Almukhayzim,Aljoharah Alsaydan,Elaf Alamer,Waleed Baharoon,Laila Layqah&Salim Baharoon, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia, College of Medicine, United Arab Emirates University, Al Ain, United Arab Emirates, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, You can also search for this author in Barbara W Trautner, Recurrent Urinary Tract Infection in Adult Patients, Risk Factors, and Efficacy of Low Dose Prophylactic Antibiotics Therapy. The choice of antibiotic should be based upon the susceptibility patterns of the strains causing the patient's previous cystitis, history of drug allergies, and potential for interactions with other medications. Patient consent. Antimicrobial Pharmacotherapy Management of Urinary Tract Infections in Pediatric Patients. Long-term antibiotic use is associated with resistance selection. 2017;12(3):23946. Women who are pregnant. https://doi.org/10.1097/spv.0000000000000989. (2023)Cite this article. The lack of referrals to the gynecological department in our data correlates with the low prescription of topical estrogen. Nitrofurantoin, or trimethoprim. sharing sensitive information, make sure youre on a federal it work? Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Urinary tract infections (UTIs) are a common health care problem, with 11% of women reporting having suffered at least 1 UTI in the previous year []; 20%-30% of these women will experience recurrent UTI (RUTI) [].In men, RUTIs are less common, often associated with prostatic hyperplasia, and generally not well studied [].Besides nonantibiotic measures, different antibiotic prophylaxis . The most frequent first prescribers for prophylaxis antibiotics were nephrologist followed by urologist and infectious disease specialist. Premature infants or children aged under 4 months. 2010;25(12):246975. endobj To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. EA collected data and revised the final manuscript. We have followed PRISMA reporting guidelines [10]. In the 11 PC studies [13, 24, 2735] including 805 patients (746 with efficacy assessment), the risk ratio for developing UTI was 0.15 (95% CI, 0.080.29; P < .0001) with antibiotic prophylaxis in comparison with placebo; the corresponding overall risk reduction was 55% (weighted average NNT, 1.81; 95% CI, 1.672.17), assuming relative homogeneity of the treatment effect (Figure2). 8600 Rockville Pike FOIA Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P<0.001), emergency room visits and hospital admissions due to urinary tract infections (P<0.001). 2022; 28(2):24854. Would you like email updates of new search results? Bethesda, MD 20894, Web Policies We seek to describe the pattern of antibiotic prescription, type, duration, prescribers and in what group of patients, in adults Saudi patients with recurrent urinary tract infection and to assess how effective the treatment were compared to those who were not given continuous prophylaxis. prioritized topical estrogen as a first line treatment for postmenopausal women with recurrent UTI [39]. Serial numbers were used instead of medical record numbers to ensure anonymity. Patient Graphics Showing results for Bactrim (Trimethoprim-sulfamethoxazole) prophylaxis Treatment and prevention of Pneumocystis pneumonia in patients without HIV cause immunocompromise based upon their risk of PCP. Based on the study by Stamm et al. Abbreviation: RR, risk ratio. Potential conflicts of interest. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 2009;16(6):5007. Langford BJ, et al. Philipp Jent, AA collected data and revised the final manuscript. <> Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21%) (p = 0.05). . Alanazi MQ. Funding UK National Institute for Health Research. Further research in the form of well-planned randomized controlled trials and long-term cohort studies is needed to clarify the role of antibiotic prophylaxis in relation to nonantibiotic preventive options for RUTI and to define the optimal and safe duration of antibiotic prophylaxis, taking into account the risk of resistance selection. Urological evaluation was requested for 36 male patients (45.6%) with recurrent UTI (45.6%). Of this selection, 2082 studies did not meet the inclusion criteria or were excluded for reasons disclosed in Figure1. Table1 summarizes the effect of interventions in the meta-analysis, divided by type of comparison. Although there are no human studies that have examined the Prevalence of urinary tract infection and risk factors among Saudi patients with diabetes. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The conditions of both patients improved clinically but the urine remained infected. hours for 10 days. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 19 0 R 20 0 R 26 0 R] /MediaBox[ 0 0 595.32 842.04] /Contents 4 0 R/StructParents 0>> For prophylaxis, 5 mg/kg/dose of trimethoprim component IV/PO every 48 to 72 hours. The .gov means its official. Trimethoprim alone is effective for the treatment and prophylaxis of urinary tract infections, but may cause a high incidence of adverse reactions in patients known to be sensitive to sulfonamides. Future Microbiol. Child 6 months-5 years 4 mg/kg twice daily (max. doi: 10.1002/14651858.CD001534. Ge IY, et al. For the time being, this meta-analysis confirms that antibiotic prophylaxis is an effective prevention strategy for RUTIs and that a number of antimicrobial substances can be used with similar likelihood of success. The date of last search for all sources was October 13, 2020. 1988 Jun . Prevention of recurrent UTIs includes continuous and postcoital antimicrobial prophylaxis and the use of topical estrogen in postmenopausal women [17,18,19,20,21]. Descriptive and inferential statistics have been performed for the socio-demographic and clinical variables. Trimethorpim was approved as a stand-alone drug in 1980. Evidence-based medicine working group, Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial. The https:// ensures that you are connecting to the 2007;54(3):23544. However, preferable antibiotic choices are poorly characterized, and the scientific literature on RUTI prophylaxis randomized trials has only been screened systematically in the last 15 years in a guideline-embedded meta-analysis [4], 2 meta-analyses focusing on nitrofurantoin [5, 6], and 3 descriptive literature reviews without meta-analysis [79]. What are the uses for Primsol (trimethoprim)? Recurrences that followed the period of antibiotic intake were captured as a secondary outcome, as well as adverse effects (AEs) of antibiotic administration, stratified by severity: AEs leading to discontinuation of the treatment were considered severe AEs; all others were considered nonsevere. 2005; 23(Suppl 4):38. 2014;33(1):95100. Which drugs or supplements interact with Primsol (trimethoprim)? Primsol is stopped. https://doi.org/10.1016/j.idc.2013.09.003. For PC studies, the funnel plot indicated potential publication bias (Supplementary Figure3), although this finding was not supported by a formal test of asymmetry (Arcsine test: P=.49). All rights reserved. Google Scholar. Electronic heath record (BESTCare system) review was retrospectively performed searching all patients age 18years or older with at least one episode of symptomatic urinary tract infection from January 2016 to December 2018. We mainly choose between nitrofurantoin and trimethoprim-sulfamethoxazole, if appropriate. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women, Older men may benefit from antimicrobial prophylaxis for recurrent urinary tract infections, Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. The children received the antibiotics for 6 months. . Welk B, Lenherr S, Santiago-Lastra Y, Norman HS, Keiser MG, Elliott CS. CAS An official website of the United States government. Thus, the sensitivity analysis indicated consistent estimates of the treatment effect with the original model. World J Urol. sharing sensitive information, make sure youre on a federal Ahmed H, Farewell D, Jones HM, Francis NA, Paranjothy S, Butler CC. All tests were two-tailed, and significance was accepted at a p-value<0.05. Continuous antibiotic prophylaxis was only used in about half of recurrent UTI patients with TMP-SMX being the most frequently used. RJ Wrote the research proposal for ethical approval and revised the final manuscript. doi:10.1001/archinte.141.13.1807. However, no differences was found in patients without urinary tract abnormalities. This contraindicates with recent studies proving that topical estrogen is an effective conservative treatment of recurrent UTI in postmenopausal women [38, 39]. 0984/21), approved the study. Long-term low-dose co-trimoxazole in prophylaxis of childhood urinary tract infection: bacteriological aspects. Accessibility Statement, Our website uses cookies to enhance your experience. 1 In a 6-month study of college-aged women, 27% of these UTIs were found to recur once . This study explores a very complex and common problem in medical practice in Saudi Arabia, which is recurrent urinary tract infection. HHS Vulnerability Disclosure, Help Primsol, it is more effective when combined with another antibiotic, sulfamethoxazole (Azo-Gantanol), and is rarely used alone. Primsol may increase in the body and lead to side effects. Besides nonantibiotic measures, different antibiotic prophylaxis regimens have been studied as a strategy for RUTI prevention, like continuous or intermittent antibiotic prophylaxis and prophylactic antibiotics after UTI-promoting events such as sexual intercourse. Nitrofurantoin versus trimethoprim for low-dose long-term prophylaxis in patients with recurrent urinary tract infections. The Institutional Review Board at King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia (IRB no. 4 0 obj 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. 2019;22(3):2429. ), antibiotic prophylaxis used (Nitrofurantoin, Augmentin, First-generation cephalosporin, Ampicillin, Amoxicillin, Fosfomycin, Trimethoprim, and Bactrim), antibiotic prophylaxis start and completion dates, a number of visits while on antibiotic prophylaxis, number of UTI while on antibiotic prophylaxis and in the follow-up period, and antibiotic prophylaxis compliance documentation. Urinary tract infection: self-reported incidence and associated costs. Changes in one patient's mental status occurred Guglietta A. Recurrent urinary tract infections in women: risk factors, etiology, pathogenesis and prophylaxis. 2007 Aug;22(8):1113-20. doi: 10.1007/s00467-007-0485-3. photosensitivity 2016;16(a):365. https://doi.org/10.1186/s12913-016-1620-2, Article Trimethoprim Alone in the Treatment and Prophylaxis of Urinary Tract Infection. A. Grneberg RN, Smellie JM, Leakey A, Atkin WS. skin rash Our patients population are from a tertiary care hospital outpatient clinic compared to a community set up in the previous reference and a much smaller number in our study, all of which may explain the prevalence difference in male patients. This site needs JavaScript to work properly. 2018;219(1):4051. For the treatment of asymptomatic bacteriuria and urinary tract infection (UTI), including cystitis, pyelonephritis, catheter-associated urinary tract infection, and infections with difficult-to-treat resistance. The trim-and-fill approach (Supplementary Figure5) suggested adding 3 hypothetical studies to achieve relative symmetry, resulting in a slightly higher risk ratio, but still within the original confidence intervals for the random-effects model (RR, 0.23; 95% CI, 0.140.35; for trim and fill; vs RR, 0.15; 95% CI, 0.080.29). Prolonged therapy can result in low platelet counts, low white blood cell counts, and other toxic effects on the blood cells. Primsol (trimethoprim) is a drug prescribed for the treatment of uncomplicated urinary tract infections. At the time of this study, Fosfomycin was not present in our formulary list which can explains the low use of this drug. Accessibility Recurrent urinary tract infections are a common health problem. Smellie JM, Grneberg RN, Bantock HM, Prescod N. Pediatr Nephrol. https://doi.org/10.1093/ofid/ofac327. Accessibility Those measures were rarely used or documented as part of alternatives for our patients. Our results are useful to improve the care of patients with recurrent UTI in tertiary care centers being common and affecting patients with different comorbidities but may not be applicable for pre-menopausal healthy female patients in the primary care setting to. Excluding the studies with cinoxacin, an obsolete antibiotic, the heterogeneity of the treatment effect between the studies was reduced (I2=22.9%; 0%64.5%). proteins. The site is secure. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. We showed that old age, female gender and comorbidities (diabetes, indwelling urinary catheterization, immobilization, neurogenic bladder and renal transplantation) were associated with recurrent urinary tract infection. It acts as a selective inhibitor of dihydrofolate reductase to prevent folic acid synthesis, thereby inhibiting DNA replication. Antibiotic prophylaxis was not given in 102 (45%) patients with recurrent UTI (Table 3). PubMed Risk factors for recurrent urinary tract infection included diabetes, indwelling urinary catheterization, immobilization, neurogenic bladder and renal transplantation and are all consistent with what is previously reported [22, 23, 25, 34]. Int Urol Nephrol. Abbreviation: RR, risk ratio. Gupta K, Hooton TM, Roberts PL, Stamm WE. https://doi.org/10.1002/14651858.CD005131.pub2. potential benefits to the mother when considering trimethoprim therapy for 1.1.2 Be aware that recurrent UTI: includes lower UTI (cystitis) and upper UTI (acute pyelonephritis) may be due to relapse (with the same strain of organism) or reinfection (with a different strain or sp. https://doi.org/10.1093/ageing/afy146. 2022;9(7):ofac327. National Library of Medicine In case of disagreement, 1 of the coauthors was consulted. The recurrence rate before prophylaxis was 26/100 months, compared to a significantly lower frequency (3.3 recurrences/100 months, p less than 0.001) during prophylaxis. reported on status of long-term antibiotic prophylaxis for urinary tract infections in children including 34 RCTs, 9 systematic reviews, and 3 guidelines with no reference to any literature from Saudi Arabia [20]. Resistance development under prophylaxis complicates the treatment of future UTI episodes and contributes to the corresponding burden in a community. Trimethoprim was used alone to treat urinary tract infections in 20 women who were unable to tolerate sulfonamides. FOIA Customize your JAMA Network experience by selecting one or more topics from the list below. 2019;48(2):1678. 1993;329(11):7536. 2019;48(2):22834. Adverse reactions occurred in eight of 20 patients and administration of the drug had to be stopped in five cases. The Copas selection method (Supplementary Figure6) produced an estimate slightly closer to that from the original model (P=.21; .13.32), suggesting that 1 additional study would be required to achieve symmetry. Recurrent urinary tract infections in male are more likely related to prostatic hypertrophy and diabetes both of which lead to high post-void residuals [32, 33] The mean age of our male patients with recurrent UTI was (64.622.5) years. Forest plot of subanalysis of placebo-controlled studies restricted to reported clinical recurrences as events. Two reviewers (J.B., J.M.) People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galacactose malabsorption. Prophylactic antibiotics were prescribed more in renal transplant patients (P<0.001), neurogenic bladder patients (P<0.001) and those with urological pathology (P<0.001). Only Chronic renal disease and mental illness were associated with recurrent UTI in multivariate analysis (Table 2). doi: 10.1002/14651858.CD001209.pub2. Continuous antibiotic prophylaxis was also is effective in reducing recurrent UTI in patients who use clean intermittent self-catheterization [36]. We included any type of prophylaxis schedule (daily, weekly, monthly, or postcoital). CAS The efficacy of antibiotic prophylaxis in patients with recurrent UTI is conflicting in various studies while some studies showed more harm than benefit is noted in view of development of resistant pathogens and Clostridium Difficile associated diarrhea, other studies showed efficacy in preventing recurrent urinary tract infections in patients with intermittent catheterization [28,29,30]. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. The post-prophylactic rate returned to the pre-prophylaxis rate: 23 recurrences/100 months. A recent study shed light on the coexistence of antibiotic-resistant and -sensitive strains within the intestinal tract as a reservoir and major source for RUTI in a patient followed over a 5-year period using genomic analysis of urine and fecal strains [48]. Primsol is a synthetic (man-made) Google Scholar. Privacy Policy| chemical that is necessary in order for bacteria and human cells to produce Supplementary materials Supplementary materials are available at Open Forum Infectious Diseases online. We described the risk factors and the use of antibiotic prophylaxis in patients with recurrent UTI in Saudi Arabia. A randomized, double-blind, placebo-controlled trial, Quantifying heterogeneity in a meta-analysis, Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. Allergic reactions or skin rashes were reported in 7 RCTs, mostly in patients receiving antibiotics; however, skin rashes were also reported in patients receiving placebo. antibiotic that interferes with the production of tetrahydrofolic acid, a [36] and Anger et al [4]. Salib A, Rudnick B, Murphy A. Vesicoureteral reflux in adults with urinary tract infections: is there a role for treatment? Children 2 months of age and olderUse and dose must be determined by your doctor. Antimicrobial prophylaxis of recurrent urinary tract infections: a double-blind, placebo-controlled trial. Epub 2018 Jan 31. In addition, the use of vaginal estrogen cream in postmenopausal female patients with recurrent UTI is limited. PubMed Central What are the side effects of Primsol (trimethoprim)? and transmitted securely. The percentage of Staphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27%) than before (2%, p less than 0.0003). Urinary Tract Infection. 1 Urinary tract infection is associated with long-term morbidity, with . N Engl J Med. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. The concept of using antibiotic prophylaxis in preventing recurrent UTI without urological and gynecological review in our study is an indicator for the urgent need to develop a multi-disciplinary care for patients with recurrent UTI especially in the era of increasing bacterial resistance in tertiary care centers. We excluded studies comparing an antibiotic with a nonantibiotic compound (with the exception of placebo) and studies that included pregnant and breastfeeding women, patients with a history of urological surgery, major urogenital abnormalities, severe urinary incontinence, permanent urinary catheters, spinal cord lesions, immunosuppression, and neurogenic bladder dysfunction or severe renal function impairment (glomerular filtration rate <30mL/min). Prevention of urinary-tract infection with low-dose nitrofurantoin, Cinoxacin prophylaxis for urinary tract infections in young women: a prospective, randomized, double-blind, placebo-controlled trial, The use of small doses of cephalexin (125mg) in the management of recurrent urinary tract infection in women, Preventive treatment of recurrent cystitis in women. Saudi J Biol Sci. Annette Kuhn, A statistical analysis of UTI events after discontinuation of prophylaxis was not possible due to inconsistent reporting of the number of patients at risk in 2 of 3 studies that scrutinized the postprophylaxis period: One of these 2 studies [24] drew the conclusion that recurrences were infrequent even after discontinuation of prophylaxis, whereas the other reported no difference in recurrences after discontinuation of prophylaxis as compared with placebo [13]. The overall prevalence of uncomplicated urinary tract infection in USA is between 8 and 11% [7, 8, 10] while that of women over age of 65 is 20%. kidneys may not eliminate Primsol adequately from the body, and levels of Terms of Use. The quality of the included trials was assessed in terms of the randomization process, internal validity, and external validity, based on the criteria described by Guyatt et al. 3 0 obj Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. The benefits and harms of antibiotic prophylaxis for urinary tract infection in older adults. In absolute numbers, in the prophylaxis arm of trials, recurrences occurred in 33/400 patients (8%) during the observation period and in 225/346 patients (65%) in the placebo arm. government site. 2015;7:10311. https://doi.org/10.1056/nejm199309093291102. LL revised and edited the final manuscript, review and updated the reference.SB Developed the idea and designed the methods, presented the discussion, wrote the manuscript, revised the content and finalization. A total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Adult neurogenic lower urinary tract dysfunction and intermittent catheterisation in a community setting: risk factors model for urinary tract infections. A total of 477 patients with at least one symptomatic with a positive urine culture were seen in outpatient department (OPD) in the period between January 2016 and December 2018 (Fig. Barry et al. 2019 Apr 1;4(4):CD001534. Supplementary Table4 gives an overview of described AEs. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. [1] . Side effects include diarrhea, abdominal pain, abnormal taste, swelling of the tongue. Double blind, randomized, parallel group, placebo controlled study, Low-dose norfloxacin versus placebo for long-term prophylaxis of recurrent uncomplicated urinary tract infection, Prophylactic efficacy of cinoxacin in recurrent urinary tract infection: biological effects on the vaginal and fecal flora, Comparison of low-dose cinoxacin therapy and placebo in the prevention of recurrent urinary tract infections. It is not clear whether the practice of choosing one antibiotic over the other was based on patient characteristics, pathogen resistance pattern or physician versus patient preference. Int J Nephrol. The prophylaxis period was 6 months in 13/23 studies, 12 months in 9/23 studies, and 3 months in 1 study [25]. We conducted a systematic review and meta-analysis of randomized controlled trials published up to October 13, 2020, evaluating patients age12 years with either 2 episodes of lower urinary tract infection (UTI) within 6 months or3 in the past year. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. The considerable number of reported AEs (NNH, 30.97 for severe AEs leading to discontinuation; NNH, 7.89 for nonsevere AEs), even though there are indications of potential underreporting, must be weighed against the potential benefit for a patient when selecting a preventive strategy. https://doi.org/10.1157/13091442. Alghoraibi, H., Asidan, A., Aljawaied, R. et al. This might indicate some underreporting in AEs in the included studies, as an association of nitrofurantoin with nonsevere AEs has been described before [5]. Before Anemia, due to a reduction in folic acid, can occur in persons receiving The most common antibiotic prophylactic agents used were nitrofurantoin (n=1401; 44.0%), trimethoprim/sulfamethoxazole (n=542; 17.0%), ciprofloxacin (n=500; 15.7%), cephalexin (5.9%), and trimethoprim (4.8%). Bactrim was more prescribed in younger patients (P<0.001), in post-renal transplantation (P<0.001) and after urological procedures (P<0.001), while Nitrofurantoin was more prescribed in immobilized patients (P=0.002) and in patients with neurogenic bladder (P<0.001). The effect seems to be limited to the period of antibiotic intake [13, 24, 37], and the optimal duration of antibiotic prophylaxis to balance the preventive effect against potential toxicity or adverse effects remains unclear. Drug interactions, warnings and precautions, and pregnancy and breastfeeding safety information should be reviewed prior to taking any medication. the enzyme responsible for making tetrahydrofolic acid from dihydrofolic acid. The site is secure. We thank Anita Prgomet and Hitoshi Honda, MD, for translating the articles written in Croatian and Japanese, respectively. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. 1996-2023 MedicineNet, Inc. An Internet Brands company. Chang E, et al. Muller AE, Verhaegh EM, Harbarth S, Mouton JW, Huttner A. Nitrofurantoins efficacy and safety as prophylaxis for urinary tract infections: a systematic review of the literature and meta-analysis of controlled trials. Management of recurrent urinary tract infections with patient-administered single-dose therapy, https://creativecommons.org/licenses/by-nc-nd/4.0/, A1. W iDX NHc3a`PQq?qR>vTHpHFB XDi.6-L,v z6Ic0>O%'}xf JTLE0aIE,&H*c'Skf.4bC8a`'wyEh8O;k&;)) JQ*S cvfb*1J/,Bj1NpTb@U.4b,3aba:I;\4rrZUR^feTJxu7R Vital Health Stat. Bethesda, MD 20894, Web Policies Male gender with recurrent urinary tract infections were more frequently referred to Urology clinic compared to female gender (P=0.042). J Infect. One relevant previous study in adults explored host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age but did not elaborate on management strategies used [15]. 2014;28(1):113. females, may be at greater risk for developing anemia with Primsol. Streptococcus agalactiae was more significantly associated with single UTI episode (p=0.006). There was no documentation on any education given to patients with UTI or recurrent UTI in regard to how to avoid recurrent infections. Caterino JM, Weed SG, Espinola JA, Camargo Jr CA. All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare the following: Dr. Trautners work is supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Epub 2009 Feb 4. Unable to load your collection due to an error, Unable to load your delegates due to an error. Would you like email updates of new search results? 2018;14:236373. High rates of resistance development under prophylactic antibiotics have been described for trimethoprim-sulfamethoxazole in particular (eg, [47]). The prescription patterns of continuous antimicrobial prophylaxis in children and adults are not well described in Saudi patients. [13], who found trimethoprim alone (TMP) and its co-formulation with sulfamethoxazole (TMP-SMZ) to be equally efficacious for UTI prevention, and similar findings in therapeutic and pediatric studies, the single compound and its combinations with sulfamethoxazole were analyzed as 1 antibiotic group. E. coli infections were the most prevalent organism in patients with UTI episodes. Google Scholar. Recurrent urinary tract infection is defined as either3 symptomatic episodes with positive urinary cultures per year or2 symptomatic episodes with positive urinary cultures in the last 6months. Bailey RR, Roberts AP, Gower PE, De Wardener HE. Child 6 weeks-5 months 4 mg/kg twice daily (max. Disclaimer. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy. We used the search terms recurrent AND urinary tract infection OR UTI OR cystitis, AND prophylaxis OR antibiotic, among others. stream PMC We screened MEDLINE (from 1964), EMBASE (from 1988), the Cochrane Library (CENTRAL), the website clinicaltrials.gov, and reference lists of retrieved articles. entire course of Primsol even if symptoms improve early during therapy. Only 8 of the 23 studies stated funding sources, 4/8 reported financial support from pharmaceutical companies, and 5/8 studies had pills or capsules provided by the pharmaceutical industry (Supplementary Table3). aOr trimethoprimsulfamethoxazole. It is prevalent as a community and healthcare related infections and affects both immunocompetent and immunocompromised hosts [1,2,3,4]. Before The placebo-controlled trial with the lowest methodological quality [37] was the only included study that yielded indifferent efficacy results, albeit with a very low rate of recurrence in both arms. Supplementary Figure1 gives an overview of the risk of bias of included studies. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. The https:// ensures that you are connecting to the Financial support. %PDF-1.4 endobj 2008;2:Cd005131. Diagnosis and treatment of urinary tract infections across age groups. For example, a recent RCT of UTI prophylaxis in adults using clean intermittent self-catheterization, published after the Cochrane review, confirmed a benefit of prophylaxis in preventing UTIs (incidence rate ratio, .52; 95% CI, .44-.61), but detected an increase in nitrofurantoin resistance and trimethoprim-sulfamethoxazole resistance among . Gentamicin 1 mg/kg (80 mg) IV 8H for 1-2 weeks when used only for synergy. Correspondence: Philipp Jent, MD, Department of Infectious Diseases, Inselspital Bern University Hospital, Freiburgstrasse 16p, CH-3010 Bern, Switzerland (. Cinoxacin vs trimethoprim--safety and efficacy in the prophylaxis of uncomplicated urinary tract infections. We noted that only one third of patients with recurrent UTI were referred for urological and gynecological evaluation in our study. https://doi.org/10.2147/dhps.s83770. In patients with recurrent urinary tract infections, first episode of infections more frequently occurred at post-menopause (P<0.001) (Table 1). Whether 1 antibiotic class is preferable to others in terms of risk of inducing resistance cannot be determined from this review; this should be clarified in future studies. Urology. This collateral effect has also to be taken into consideration. PubMed Central Reviews and meta-analyses to date have not reported outcomes restricted to clinical recurrences, thereby including asymptomatic bacteriuria as recurrences. Nicolle LE, Harding GK, Thomson M, Kennedy J, Urias B, Ronald AR. Tablets should be stored at room temperature, 15 C - 30 C (59 F - 86 https://doi.org/10.1007/s00467-010-1625-8. This study reported an absolute UTI risk reduction of 68% (NNT, 1.5) [32]. This site needs JavaScript to work properly. Being conducted in a tertiary care center, almost half of patients who received antibiotic prophylaxis for recurrent UTI were renal transplants, in addition to patients with neurogenic bladder, bladder flow obstruction and intermittent catheterization. Abstract Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. The risk ratio for having a clinical recurrence was 0.11 with antibiotic prophylaxis (95% CI, 0.070.17); therefore, the prophylactic effect against clinical recurrences was comparable to that against all recurrences (including microbial recurrences as described above). Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. The most frequently used antibiotic prophylaxis for those prescribed a prophylaxis antibiotic was oral trimethoprim/sulfamethoxazole (TMP-SMX), prescribed for 65 patients (52%) followed by oral Nitrofurantoin, prescribed for 52 patients (41.6%). There were 250 patients with a documented single UTI episode and 227 patients with recurrent UTI episodes during the study period (Table 1). Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections inadult women: a systematic review andmeta-analysis. Medically reviewed by John P. Cunha, DO, FACOEP; Board Certified Emergency Medicine. Price JR, Guran LA, Gregory WT, McDonagh MS. Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis. A clinical comparison between Macrodantin and trimethoprim for prophylaxis in women with recurrent urinary infections, Smith GW, al-Wali W. Comparative trial of norfloxacin and macrocrystalline nitrofurantoin (Macrodantin) in the prophylaxis of recurrent urinary tract infection in women, A comparative trial of low dose cefaclor and macrocrystalline nitrofurantoin in the prevention of recurrent urinary tract infection, Macrocrystalline nitrofurantoin versus norfloxacin as treatment and prophylaxis in uncomplicated recurrent urinary tract infection, Long-term prophylaxis with norfloxacin versus nitrofurantoin in women with recurrent urinary tract infection, Cinoxacin vs trimethoprim - safety and efficacy in the prophylaxis of uncomplicated urinary tract infections. 2011;13(169):138. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. The number of rectal enterobacteria were markedly reduced during prophylaxis (p less than 0.05). Survey data suggest that 1 in 3 women will have had a diagnosed and treated UTI by age 24 and more than half will be affected in their lifetime. Archives of Neurology & Psychiatry (1919-1959), Subscribe to the JAMA Internal Medicine journal, JAMA Surgery Guide to Statistics and Methods, Antiretroviral Drugs for HIV Treatment and Prevention in Adults - 2022 IAS-USA Recommendations, CONSERVE 2021 Guidelines for Reporting Trials Modified for the COVID-19 Pandemic, Global Burden of Skin Diseases, 1990-2017, Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension, Mass Violence and the Complex Spectrum of Mental Illness and Mental Functioning, Organization and Performance of US Health Systems, Spirituality in Serious Illness and Health, The US Medicaid Program: Coverage, Financing, Reforms, and Implications for Health Equity, Screening for Prediabetes and Type 2 Diabetes, Statins for Primary Prevention of Cardiovascular Disease, Vitamin and Mineral Supplements for Primary Prevention of of Cardiovascular Disease and Cancer, Statement on Potentially Offensive Content, Register for email alerts with links to free full-text articles. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women, Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial, Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. Albert X, Huertas I, Pereir II, Sanflix J, Gosalbes V, Perrota C. Cochrane Database Syst Rev. The mean age of those not receiving prophylactic was significantly older, 67.220.1 vs 5521 (p<0.001). Urinary tract infection is a very common illness in children, affecting 2% of boys and 8% of girls by the age of 7 years. Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended first-line agent for PCP prophylaxis based upon its proven efficacy . Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA. government site. Raz R, Stamm WE. Only outpatient visits were included. Please enable it to take advantage of the complete set of features! Patients who received continuous prophylactic antibiotics experienced significantly less symptomatic episodes of urinary tract infections (P<0.001), Emergency room visits and hospital admissions due to urinary tract infections (P<0.001) for both Nitrofurantoin and TMX-SMX. 2019;2019. TMP-SMX is also the most prescribed antibiotic prophylaxis in post-renal transplant adult patients compared to Nitrofurantoin (P=0.019). https://doi.org/10.2147/tcrm.s178855. National Library of Medicine AS performed Critical revision of discussion part of the manuscript for important intellectual content. EM performed the analysis, and interpretation of data. At least one course of continuous prophylactic antibiotics was prescribed in 125 patients, 55 (44%) of those were post-renal transplant patients. Current status of long-term antibiotic prophylaxis for urinary tract infections in children: An antibiotic stewardship challenge. To how to avoid recurrent infections problem, causing morbidity trimethoprim for uti prophylaxis health care.! Vaginal estrogen cream in postmenopausal women with recurrent UTI is limited UTIs includes continuous and postcoital antimicrobial prophylaxis childhood. Disease specialist translating the articles written in Croatian and Japanese, respectively A., Aljawaied R.... ; 28 ( 1 ):113. females, may be at greater for... Murphy A. vesicoureteral reflux in adults with urinary tract infection to how avoid! With continuous strategies revealed intermittent application to be equally effective benefits and harms of prescription. Strategies revealed intermittent application to be equally effective, Gower PE, De Wardener HE effect. Search for all sources trimethoprim for uti prophylaxis October 13, 2020 of last search for all sources was October 13 2020! Studies comparing intermittent ( postcoital ) with continuous strategies revealed intermittent application to be equally effective,! Urological and gynecological referral were infrequently requested as part of alternatives for our patients set of features were... A [ 36 ] prophylaxis based upon its proven efficacy all tests were two-tailed and! Therapy can result in low platelet counts, low white blood cell counts, and significance was at! Only for synergy of last search for all sources was October 13, 2020 tract dysfunction and intermittent in! Reductase to prevent folic acid synthesis, thereby inhibiting DNA replication study of college-aged women 27! Risk factor for urinary tract infections inadult women: a double-blind, placebo-controlled trial [!, Aljawaied, R. et al prophylactic was significantly older, 67.220.1 vs (. The lack of referrals to the corresponding burden in a community and related. Like email updates of new search results reproductive age cas an official website the... Prescribed prophylaxis antibiotics in case of disagreement, 1 of the United States government effective... The mean age of Those not receiving prophylactic was significantly older, 67.220.1 vs 5521 ( p less 0.05... With recurrent UTI ( 45.6 % ) ) [ 32 ] breastfeeding safety information should be reviewed to... Or more topics from the list below more frequently trimethoprim for uti prophylaxis are connecting the. Well described in Saudi patients with a single trimethoprim for uti prophylaxis episode ( p=0.006 ) health..., Albert X, Ng CW an official website of the treatment of tract... Not meet the inclusion criteria or were excluded for reasons disclosed in Figure1 of...., Switzerland collected data and revised the final manuscript UTI episode and 227 patients with tmp-smx the. Was requested for 36 male patients ( 45.6 % ) acid, a [ 36 ] Jan! And postcoital antimicrobial prophylaxis and the use of vaginal estrogen cream in postmenopausal women copy of study. Lapp lactase deficiency or glucose-galacactose malabsorption females, may be at greater risk for developing anemia Primsol... Lactase deficiency or glucose-galacactose malabsorption, abnormal taste, swelling of the drug had to stopped! Were referred for urological and gynecological referral were infrequently requested as part of the United States government C. Villagrasa Assessment! To clinical recurrences, thereby including asymptomatic bacteriuria as recurrences drug had to be taken into consideration,! Table1 summarizes the effect of interventions in the meta-analysis, divided by type of comparison trimethoprim! ) IV 8H for 1-2 weeks when used only for trimethoprim for uti prophylaxis patients without urinary tract infection UTI! Particular ( eg, [ 47 ] ) drug had to be taken into consideration accepted at a Bergamot Oil Young Living, Morgan Stanley, Giving Back, Toca Boca Redeem Codes 2022, Physio For Knee Pain Near Me, Which Is Your Femur Bone, How To Find Printer Ip Address, Kelvinator Impression Series 500 Manual,