scholarly journals Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? A feasibility randomised trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e046791
Author(s):  
Oghenekome Gbinigie ◽  
Julie Allen ◽  
Nicola Williams ◽  
Michael Moore ◽  
Alastair D Hay ◽  
...  
Keyword(s):  
General Practice ◽  
Urinary Tract ◽  
Outcome Measures ◽  
Randomised Trial ◽  
Antibiotic Use ◽  
Secondary Outcome ◽  
Uncomplicated Urinary Tract Infection ◽  
Tract Infections ◽  
Lost To Follow Up

ObjectivesTo determine the feasibility of conducting a randomised trial of the effectiveness of cranberry extract in reducing antibiotic use by women with symptoms of acute, uncomplicated urinary tract infection (UTI).DesignOpen-label feasibility randomised parallel group trial.SettingFour general practices in Oxfordshire.ParticipantsWomen aged 18 years and above presenting to general practice with symptoms of acute, uncomplicated UTI.InterventionsWomen were randomly assigned using Research Electronic Data Capture in a 1:1:1 ratio to: (1) immediate antibiotics alone (n=15); (2) immediate antibiotics and immediate cranberry capsules for up to 7 days (n=15); or (3) immediate cranberry capsules and delayed antibiotics for self-initiation in case of non-improvement or worsening of symptoms (n=16).Primary and secondary outcome measuresThe primary outcome measures were: rate of recruitment of participants; numbers lost to follow-up; proportion of electronic diaries completed by participants; and acceptability of the intervention and study procedures to participants and recruiters. Secondary outcomes included an exploration of differences in symptom burden and antibiotic use between groups.ResultsFour general practitioner practices (100%) were opened and recruited participants between 1 July and 2 December 2019, with nine study participants recruited per month on average. 68.7% (46/67) of eligible participants were randomised (target 45) with a mean age of 48.4 years (SD 19.9, range 18–81). 89.1% (41/46) of diaries contained some participant entered data and 69.6% (32/46) were fully complete. Three participants (6.5%) were lost to follow-up and two (4.4%) withdrew. Of women randomly assigned to take antibiotics alone (controls), one-third of respondents reported consuming cranberry products (33.3%, 4/12). There were no serious adverse events.ConclusionsIt appears feasible to conduct a randomised trial of the use of cranberry extract in the treatment of acute, uncomplicated UTI in general practice.Trial registration numberISRCTN Registry (ID: 10399299).

scholarly journals A COMPARATIVE RANDOMIZED STUDY OF NITROFURANTOIN AND FOSFOMYCIN IN THE TREATMENT OF URINARY TRACT INFECTIONS IN NONPREGNANT WOMEN AT A TERTIARY CARE RURAL HOSPITAL, KARNATAKA.

2020 ◽  
pp. 35-38
Author(s):  
Pooja Bhat ◽  
Mahendra G ◽  
Anushree Patel
Keyword(s):  
Single Dose ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Randomized Study ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Study Population ◽  
Tract Infections ◽  
Lost To Follow Up

INTRODUCTION: Urinary tract infections are the most common infections seen in the hospital setting and take the second lead after respiratory tract infection in community acquired infections. Nitrofurantoin and Fosfomycin are older drugs that are being revived and recommended as first-line agents in treating uncomplicated UTI. AIMS AND OBJECTIVES: To assess the comparative efficacy of 5day nitrofurantoin versus single dose fosfomycin for clinical resolution in uncomplicated UTI. MATERIALS AND METHODS: This randomized clinical trial was conducted from January 2019 to September 2019 at the Department of Obstetrics and Gynaecology, AIMS, B G Nagara, Mandya, Karnataka. Patients were randomized to either oral nitrofurantoin 100mg twice daily for 5 days or single dose of oral fosfomycin 3g. Baseline urine routine was done. They were followed up at 14(+/-2) and 28(+/-7) days after completion of antibiotic therapy which was considered at day 5 as fosfomycin has long half-life. The data was entered in Microsoft Excel and outcomes were analysed using Epi Info software. RESULTS: Out of total 92 patients screened,63 were enrolled and randomized. Thirty-two (50.7%) were given nitrofurantoin and 31 (49.2%) received fosfomycin. Of total enrolled after screening 3 (4.7%) patients were lost to follow-up, so only 60 patients (n=92, 65.2%) comprised the study population. CONCLUSION: Five-day nitrofurantoin is superior to single dose fosfomycin in treatment of acute uncomplicated UTI.

scholarly journals 1429. Real-World Study of Patients with Uncomplicated Urinary Tract Infection in the United States: High-Risk Comorbid Conditions and Burden of Illness

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S796-S797
Author(s):  
Madison T Preib ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Daniel C Gibbons ◽  
Xiaoxi Sun ◽  
...  
Keyword(s):  
Urinary Tract ◽  
High Risk ◽  
Real World ◽  
Index Date ◽  
Oral Antibiotic ◽  
Uncomplicated Urinary Tract Infection ◽  
Comorbid Conditions ◽  
Tract Infections ◽  
High Risk Cohort

Abstract Background Urinary tract infections (UTIs) are associated with significant morbidity and economic burden, particularly in the elderly and patients with comorbidities. We used real-world data (RWD) to assess healthcare resource use (HRU) and costs in patients with uncomplicated UTI (uUTI) and high-risk comorbid conditions in the US. Methods This was a retrospective cohort study (IBM MarketScan RWD, commercial/Medicare Supplemental claims January 1, 2014–December 31, 2017) of females ≥ 12 years of age with uUTI who had an oral antibiotic prescription ± 5 days of uUTI diagnosis (index date) and continuous health-plan enrollment for ≥ 1 year pre-/post index date. Five high-risk cohorts and matched-control cohorts (baseline age, region) were identified: controlled type 2 diabetes (T2D), mild/moderate chronic kidney disease (CKD), recurrent UTI (rUTI), elderly (ELD), and postmenopausal (PMP) (Table 1). Sample sizes were balanced via random match selection (1:5 case:control). uUTI-related HRU and costs were compared between cases and controls (index episode/1-year follow-up) using multivariable generalized linear models. Table 1. Cohort assignment for high-risk cohorts and controls Results Of 339,100 patients with uUTI, case/control cohorts comprised T2D, n=15,423/n=77,115; CKD, n=1041/n=5205; rUTI, n=7937/n=39,685; ELD, n=23,666/n=118,330; and PMP, n=105,608/n=211,216 patients. HRU trends across cohorts varied. During 1-year followup, outpatient visits were significantly different for cases versus controls in the T2D, rUTI, and PMP cohorts (p ≤ 0.0079), with higher case than control values in the rUTI and PMP cohorts; pharmacy claims were significantly higher for rUTI, ELD, and PMP cases, and inpatient visits were significantly higher for ELD and PMP cases, versus controls (all p < 0.0001; Table 2). Adjusted total uUTI-related costs (emergency room + outpatient + pharmacy) were significantly different (p < 0.0001) for cases versus controls at index episode and during follow-up in all cohorts except CKD: case values were higher than controls at index episode and during follow-up in the T2D cohort, and during follow-up in the rUTI and ELD cohorts (Table 3). Table 2. uUTI-related HRU* for cases versus controls according to high-risk cohort Table 3. uUTI-related costs* for cases versus controls according to high-risk cohort Conclusion Females in some high-risk case cohorts had higher uUTI-related HRU and costs versus controls. Further studies of relationships between comorbidities and uUTI burden are needed. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals 1422. Real-World Study of the Effects of Inappropriate or Suboptimal Treatment on the Burden of Illness Among Patients with Uncomplicated Urinary Tract Infection and High-Risk Comorbid Conditions in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S794-S795
Author(s):  
Madison T Preib ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Daniel C Gibbons ◽  
Xiaoxi Sun ◽  
...  
Keyword(s):  
Urinary Tract ◽  
High Risk ◽  
Real World ◽  
Index Date ◽  
The United States ◽  
Uncomplicated Urinary Tract Infection ◽  
Comorbid Conditions ◽  
Tract Infections ◽  
High Risk Cohort

Abstract Background Urinary tract infections (UTIs) are associated with significant morbidity and economic burden. Nitrofurantoin (NFT) and fosfomycin are among the first-line treatments for uncomplicated UTI (uUTI) recommended by Infectious Diseases Society of America (IDSA) 2011 guidance. We used real-world data (RWD) to assess patterns of appropriate and optimal (AP&OP) and inappropriate or suboptimal (IA/SO) antibiotic (AB) prescribing (RX), and related healthcare resource use (HRU) and costs, in US uUTI patients with high-risk comorbid conditions. Methods This was a retrospective cohort study of RWD (IBM MarketScan, commercial/Medicare Supplemental claims January 1, 2014–December 31, 2017) in females ≥ 12 years of age with uUTI, who had an oral AB prescription ± 5 days of uUTI diagnosis (index date) and continuous health-plan enrollment ≥ 1 year pre-/post-index date. Patients were stratified into high-risk cohorts (Table 1) and by AB RX (AP&OP and IA/SO) during first uUTI episode (within 28 days of index). AP&OP RX followed IDSA guidance, IA RX did not; SO RX was considered a proxy for treatment failure (e.g., AB switch or a second UTI diagnosis [acute care setting] in index episode). Sample size was balanced via random match selection, AP&OP:IA/SO ratio 1:5 (age and region). uUTIrelated HRU and costs were compared between cohorts (at index episode and 1-year follow-up) via multivariable analysis. Table 1. High-risk cohorts identified in the study Results IA/SO AB RX was highest in the elderly cohort (94.3%, likely influenced by renal impairment/no NFT RX in this group) and > 90% in other cohorts; AP&OP AB RX was highest in the postmenopausal cohort (9.0%). IA/SO AB RX in all cohorts was associated with significantly higher uUTI-related HRU (outpatient visits and pharmacy claims) per index episode/during follow-up versus AP&OP AB RX (p ≤ 0.0237, Table 2). IA/SO AB RX in all cohorts was associated with significantly higher adjusted total costs per index episode/during follow-up versus AP&OP AB RX (p < 0.05; Table 3). Table 2. uUTI-related HRU* per patient according to high-risk cohort and stratified by AB RX Table 3. uUTI-related costs* per patient according to high-risk cohort and stratified by AB RX Conclusion Over 90% of females in each high-risk cohort identified had IA/SO AB RX (outside IDSA 2011 guidance for uUTI treatment), leading to high HRU and cost burden. This suggests an unmet need for uUTI symptom relief, new treatments, training, and improved RX practices in the US and, furthermore, a need for additional research in this area. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals Quality of the Diagnostic Process, Treatment Decision, and Predictors for Antibiotic Use in General Practice for Nursing Home Residents with Suspected Urinary Tract Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 316
Author(s):  
Stine Dyhl Sommer-Larsen ◽  
Sif Helene Arnold ◽  
Anne Holm ◽  
Julie Aamand Olesen ◽  
Gloria Cordoba
Keyword(s):  
General Practice ◽  
Nursing Home ◽  
Urinary Tract ◽  
Urine Culture ◽  
Treatment Decision ◽  
Antibiotic Use ◽  
Diagnostic Process ◽  
Urinary Tract Symptoms ◽  
Tract Infections

Urinary tract infections (UTIs) are common in nursing home (NH) residents and Denmark is one of the countries with the highest antibiotic use in NHs. The aim of this study was to assess the quality of the diagnostic process and treatment decision on the day of the first contact from NHs to general practice and assess predictors for prescription of antibiotics in NH residents without an indwelling urinary catheter. The study was a prospective observational study in general practice in the Capital Region of Denmark; 490 patients were included; 158 out of 394 (40.1%, 95% CI 35; 45) patients with suspected UTI had urinary tract symptoms; 270 out of 296 (91.2%, 95% CI 87; 94) patients without urinary tract symptoms had a urine culture performed. Performing urine culture in the general practice was inversely associated to prescription of antibiotics on day one (OR 0.27, 95% CI 0.13; 0.56). It is imperative to support the implementation of interventions aimed at improving the quality of the diagnostic process on day one, as less than half of the patients given the diagnosis “suspected UTI” had urinary tract symptoms, and most patients without urinary tract symptoms had a urine culture performed.

scholarly journals 1434. Treatment Patterns, Healthcare Resource Use, and Associated Costs in Females with Uncomplicated Urinary Tract Infection in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S798-S799
Author(s):  
Rena Moon ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Daniel C Gibbons ◽  
Alex Kartashov ◽  
...  
Keyword(s):  
Applied Sciences ◽  
Urinary Tract ◽  
Resource Use ◽  
Healthcare Resource ◽  
Uncomplicated Urinary Tract Infection ◽  
Healthcare Resource Use ◽  
Ed Visits ◽  
Tract Infections ◽  
Switch Group

Abstract Background Urinary tract infections (UTIs) disproportionately affect women and are a substantial burden on healthcare systems. We assessed the effect of antibiotic (AB) switching on UTI recurrence, healthcare resource use (HRU), and related costs among adolescent and adult females in the US with uncomplicated UTIs (uUTIs). Methods This retrospective cohort study used US Optum claims data (United Healthcare, January 1, 2013–December 31, 2018). Eligible patients were females ≥ 12 years of age with an acute uUTI diagnosis at outpatient or emergency department (ED) visit (index date) and an oral AB prescription within ± 5 days of index. Patients with recurrent UTIs (rUTIs), defined as 2 UTI diagnoses (including index) in 6 months or ≥ 3 UTI diagnoses (including index) in 12 months, were included; those with complicated UTI were excluded. Patients were assigned to two groups: AB switch (≥ 2 filled prescriptions of different AB within 28 days post index [uUTI episode]) and no AB switch. Results In 5870 eligible patients (mean age 44.5 years; 76.6% White), ciprofloxacin (CIP; 38.6%), nitrofurantoin (NFT; 31.4%), and trimethoprim-sulfamethoxazole (TMP-SMX; 25.6%) were the most commonly prescribed first-line ABs at index, and 567 (9.7%) patients switched AB. CIP was switched to NFT and TMP-SMX in 2.0% and 1.7% of patients, respectively. NFT was switched to CIP and TMP-SMX in 2.6% and 1.5% of patients, respectively. TMP-SMX was switched to CIP and NFT in 3.0% and 2.4% of patients, respectively. During index visit, the AB switch group had higher mean ambulatory care and pharmacy claims (both p < 0.001), and higher total mean HRU costs (&2186.4) per patient compared with the no switch group (&1508.8; p = 0.011). More patients had rUTI in the AB switch group (18.9%) versus the no switch group (14.2%; p < 0.001), and more had ED visits in the AB switch group than the no switch group (p < 0.0001) (Table 1). During follow-up, the AB switch group had a higher mean number of uUTI episodes per patient (p < 0.001; Table 1), and more patients had UTI-related ED visits (10.8%) compared with the no switch group (7.7%; p = 0.010; Table 2). Table 1. Primary outcomes of uncomplicated UTI outpatients during January 1, 2013–December 31, 2018, stratified by any switch in AB use during index episode Table 2. Primary outcomes of uncomplicated UTI outpatients during January 1, 2013–December 31, 2018, stratified by any switch in AB use during 12-month follow-up Conclusion US females with uUTI who switched AB had more rUTI cases and increased overall costs and HRU compared with those who did not switch AB, suggesting an unmet need for improved prescribing practices. Disclosures Rena Moon, MD, Premier Applied Sciences, Premier Inc. (Employee) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Alex Kartashov, PhD, Premier Applied Sciences, Premier Inc. (Employee) Ning Rosenthal, MD, Premier Applied Sciences, Premier Inc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

scholarly journals Comparison of General Practice and Pharmaceutical Dispensing Data for Pharmacoepidemiological Research: Assessing the Risk of Urinary-Tract Infections with Sodium Glucose Cotransporter 2 Inhibitors for Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Svetla Gadzhanova ◽  
Elizabeth Roughead
Keyword(s):  
General Practice ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Dipeptidyl Peptidase 4 ◽  
Sodium Glucose Cotransporter ◽  
Reliable Source ◽  
Pharmacy Data ◽  
Tract Infections ◽  
Dispensing Data

Background. This study compared results of a study undertaken using Australia’s general practice electronic health record database, MedicineInsight, to assess risk of urinary-tract infections with sodium glucose cotransporter 2 inhibitors (SGLT2) for diabetes, by undertaking the same study in a 10% random sample of data from the national Pharmaceutical Benefits Scheme data. Methods. Cohort studies were undertaken using deidentified data from the two national datasets. In each dataset, initiators of SGLT2 inhibitors were compared to initiators of dipeptidyl peptidase 4 (DPP-4) inhibitors in the period Jan 2012 to Sep 2015. The risk of urinary-tract infections (UTI) was assessed in six-month follow-up after initiation of SGLT2 and DPP-4. Results. There were 1,977 people in the SGLT2 and 1,964 people in the DPP-4 cohort (MedicineInsight data) and 3,120 in the SGLT2 and 12,359 in the DPP-4 cohort (10% PBS data). In both datasets, the risk of UTI after initiation of SGLT2 was not significantly increased in comparison to DPP-4 cohort (MedicineInsight: 3.6% versus 4.9%; aHR=0.90, 95% CI 0.66-1.24; PBS: 3.0% versus 3.9%; aHR=0.90, 95% CI 0.72-1.13, 10%). Conclusions. Comparison of MedicineInsight data to PBS national pharmacy data demonstrated highly comparable results for the specific study question. MedicineInsight is a reliable source of data that can be used for pharmacoepidemiological studies.

Infections and use of antibiotics in residents of long-term care facilities in Hungary

2014 ◽  
Vol 155 (23) ◽  
pp. 911-917 ◽  
Author(s):  
Rita Szabó ◽  
Karolina Böröcz
Keyword(s):  
Urinary Tract ◽  
Long Term Care ◽  
Soft Tissues ◽  
Good Practice ◽  
Antibiotic Use ◽  
Prevalence Survey ◽  
Term Care ◽  
Care Facilities ◽  
Tract Infections

Introduction: Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. Aim: The aim of the authors was to present the results of the European survey which were obtained in Hungary. Method: In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. Results: The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of “antibacterials for systemic use”. Conclusions: The results emphasise the need for a national guideline and education for good practice in long-term care facilities. Orv. Hetil., 2014, 155(23), 911–917.

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696833 ◽  
Author(s):  
Leah Ffion Jones ◽  
Emily Cooper ◽  
Cliodna McNulty
Keyword(s):  
Older Adults ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Care Home ◽  
Asymptomatic Bacteriuria ◽  
Theoretical Domains Framework ◽  
Antibiotic Use ◽  
Primary Care Providers ◽  
Care Providers ◽  
Tract Infections

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

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