Cranberry Extract for Symptoms of Acute, Uncomplicated Urinary Tract Infection: A Systematic Review

Background: Effective alternatives to antibiotics for alleviating symptoms of acute infections may be appealing to patients and enhance antimicrobial stewardship. Cranberry-based products are already in wide use for symptoms of acute urinary tract infection (UTI). The aim of this review was to identify and critically appraise the supporting evidence. Methods: The protocol was registered on PROSPERO. Searches were conducted of Medline, Embase, Amed, Cinahl, The Cochrane library, Clinicaltrials.gov and WHO International Clinical Trials Registry Platform. We included randomised clinical trials (RCTs) and non-randomised studies evaluating the effect of cranberry extract in the management of acute, uncomplicated UTI on symptoms, antibiotic use, microbiological assessment, biochemical assessment and adverse events. Study risk of bias assessments were made using Cochrane criteria. Results: We included three RCTs (n = 688) judged to be at moderate risk of bias. One RCT (n = 309) found that advice to consume cranberry juice had no statistically significant effect on UTI frequency symptoms (mean difference (MD) −0.01 (95% CI: −0.37 to 0.34), p = 0.94)), on UTI symptoms of feeling unwell (MD 0.02 (95% CI: −0.36 to 0.39), p = 0.93)) or on antibiotic use (odds ratio 1.27 (95% CI: 0.47 to 3.43), p = 0.64), when compared with promoting drinking water. One RCT (n = 319) found no symptomatic benefit from combining cranberry juice with immediate antibiotics for an acute UTI, compared with placebo juice combined with immediate antibiotics. In one RCT (n = 60), consumption of cranberry extract capsules was associated with a within-group improvement in urinary symptoms and Escherichia coli load at day 10 compared with baseline (p < 0.01), which was not found in untreated controls (p = 0.72). Two RCTs were under-powered to detect differences between groups for outcomes of interest. There were no serious adverse effects associated with cranberry consumption. Conclusion: The current evidence base for or against the use of cranberry extract in the management of acute, uncomplicated UTIs is inadequate; rigorous trials are needed.

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Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-035074 ◽

2020 ◽

Vol 10 (8) ◽

pp. e035074

Author(s):

Ingvild Vik ◽

Ibrahimu Mdala ◽

Marianne Bollestad ◽

Gloria Cristina Cordoba ◽

Lars Bjerrum ◽

...

Keyword(s):

Urinary Tract Infection ◽

Logistic Regression ◽

Urinary Tract ◽

Randomised Controlled Trial ◽

Tract Infection ◽

Controlled Trial ◽

Antibiotic Use ◽

Uncomplicated Urinary Tract Infection ◽

Baseline Information ◽

Randomised Controlled

ObjectiveTo predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI).Setting16 sites in a primary care setting in Norway, Sweden and Denmark.ParticipantsData from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.MethodsUsing the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.ResultsOf the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).ConclusionWe did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.Trial registration numberClinicalTrials.gov (NCT01849926).

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Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review

British Journal of General Practice ◽

10.3399/bjgp20x712781 ◽

2020 ◽

Vol 70 (699) ◽

pp. e714-e722

Author(s):

Tammy Hoffmann ◽

Ruwani Peiris ◽

Chris Del Mar ◽

Gina Cleo ◽

Paul Glasziou

Keyword(s):

Systematic Review ◽

Urinary Tract Infection ◽

Placebo Group ◽

Urinary Tract ◽

Natural History ◽

Tract Infection ◽

Risk Of Bias ◽

Uncomplicated Urinary Tract Infection ◽

Randomised Trials ◽

History Of

BackgroundAlthough uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established; this hampers informed decision making about antibiotic use.AimTo determine the natural history of uncomplicated UTI in adults.Design and settingSystematic review.MethodPubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted.ResultsThree randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36%; up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant.ConclusionAlthough some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.

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Rural–urban differences in antibiotic prescribing for uncomplicated urinary tract infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.21 ◽

2021 ◽

pp. 1-8

Author(s):

Abbye W. Clark ◽

Michael J. Durkin ◽

Margaret A. Olsen ◽

Matthew Keller ◽

Yinjiao Ma ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Rural Women ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Oral Antibiotic ◽

Uncomplicated Urinary Tract Infection ◽

Urban Status ◽

To Receive

Abstract Objective: To examine rural–urban differences in temporal trends and risk of inappropriate antibiotic use by agent and duration among women with uncomplicated urinary tract infection (UTI). Design: Observational cohort study. Methods: Using the IBM MarketScan Commercial Database (2010–2015), we identified US commercially insured women aged 18–44 years coded for uncomplicated UTI and prescribed an oral antibiotic agent. We classified antibiotic agents and durations as appropriate versus inappropriate based on clinical guidelines. Rural–urban status was defined by residence in a metropolitan statistical area. We used modified Poisson regression to determine the association between rural–urban status and inappropriate antibiotic receipt, accounting for patient- and provider-level characteristics. We used multivariable logistic regression to estimate trends in antibiotic use by rural–urban status. Results: Of 670,450 women with uncomplicated UTI, a large proportion received antibiotic prescriptions for inappropriate agents (46.7%) or durations (76.1%). Compared to urban women, rural women were more likely to receive prescriptions with inappropriately long durations (adjusted risk ratio 1.10, 95% CI, 1.10–1.10), which was consistent across subgroups. From 2011 to 2015, there was slight decline in the quarterly proportion of patients who received inappropriate agents (48.5% to 43.7%) and durations (78.3% to 73.4%). Rural–urban differences varied over time by agent (duration outcome only), geographic region, and provider specialty. Conclusions: Inappropriate antibiotic prescribing is quite common for the treatment of uncomplicated UTI. Rural women are more likely to receive inappropriately long antibiotic durations. Antimicrobial stewardship interventions are needed to improve outpatient UTI antibiotic prescribing and to reduce unnecessary exposure to antibiotics, particularly in rural settings.

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Point-of-care urine culture for managing urinary tract infection in primary care: a randomised controlled trial of clinical and cost-effectiveness

British Journal of General Practice ◽

10.3399/bjgp18x695285 ◽

2018 ◽

Vol 68 (669) ◽

pp. e268-e278 ◽

Cited By ~ 10

Author(s):

Christopher C Butler ◽

Nick A Francis ◽

Emma Thomas-Jones ◽

Mirella Longo ◽

Mandy Wootton ◽

...

Keyword(s):

Primary Care ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Standard Care ◽

Urine Culture ◽

Point Of Care ◽

Antibiotic Use ◽

Laboratory Culture ◽

Uncomplicated Urinary Tract Infection

BackgroundThe effectiveness of using point-of-care (POC) urine culture in primary care on appropriate antibiotic use is unknown.AimTo assess whether use of the Flexicult™ SSI-Urinary Kit, which quantifies bacterial growth and determines antibiotic susceptibility at the point of care, achieves antibiotic use that is more often concordant with laboratory culture results, when compared with standard care.Design and settingIndividually randomised trial of females with uncomplicated urinary tract infection (UTI) in primary care research networks (PCRNs) in England, the Netherlands, Spain, and Wales.MethodMultilevel regression compared outcomes between the two groups while controlling for clustering.ResultsIn total, 329 participants were randomised to POC testing (POCT) and 325 to standard care, and 324 and 319 analysed. Fewer females randomised to the POCT arm than those who received standard care were prescribed antibiotics at the initial consultation (267/324 [82.4%] versus 282/319 [88.4%], odds ratio [OR] 0.56, 95% confidence interval [CI] = 0.35 to 0.88). Clinicians indicated the POCT result changed their management for 190/301 (63.1%). Despite this, there was no statistically significant difference between study arms in antibiotic use that was concordant with laboratory culture results (primary outcome) at day 3 (39.3% POCT versus 44.1% standard care, OR 0.84, 95% CI = 0.58 to 1.20), and there was no evidence of any differences in recovery, patient enablement, UTI recurrences, re-consultation, antibiotic resistance, and hospitalisations at follow-up. POCT culture was not cost-effective.ConclusionPoint-of-care urine culture was not effective when used mainly to adjust immediate antibiotic prescriptions. Further research should evaluate use of the test to guide initiation of ‘delayed antibiotics’.

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MP032: Do urine cultures in the emergency department change management of young women with symptoms of uncomplicated urinary tract infection?

CJEM ◽

10.1017/cem.2016.173 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S77-S77 ◽

Cited By ~ 1

Author(s):

E. Poon ◽

L. Self ◽

S.L. McLeod ◽

S. Caine ◽

B. Borgundvaag

Keyword(s):

Emergency Department ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Change Management ◽

Post Partum ◽

Recurrent Infection ◽

Retrospective Chart Review ◽

Antibiotic Use ◽

Uncomplicated Urinary Tract Infection

Introduction: Current guidelines do not recommend the routine use of urinary cultures in the management of uncomplicated urinary tract infection (UTI) in premenopausal, non-pregnant women. Complicating factors include atypical presentation, structural abnormalities or recent recurrent infection/antibiotic use. The objective of this study was to determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and whether a culture result impacted subsequent management. Methods: This was a retrospective chart review of women aged 18-39 presenting to one of two academic EDs with a discharge diagnosis of uncomplicated UTI from Jan-Dec 2014. Patients were excluded if any of the following were documented: pregnancy, fever, immunocompromised state, diabetes mellitus, absence of lower urinary tract symptoms, ED administration of intravenous antibiotics, a previous UTI treated with antibiotics in the last 90 days, two weeks post-partum or post-instrumentation. Results: Of the 512 charts included in the analysis, 494 (96.5%) patients had a urinalysis, of which 463 (93.7%) had positive leukocyte esterase and 90 (18.2%) had positive nitrites. 370 patients (72.3%) had urine cultures performed, of which 236 (63.8%) were positive. 505 (98.6%) patients received antibiotics (53.9% Macrobid; 22.6% Ciprofloxacin; 15.0% Septra; 6.7% other; 1.8% not documented). 7 (1.9%) cultures grew organisms resistant to the prescribed antibiotic; 2 (0.5%) patients received new prescriptions. Conclusion: For the majority of young female patients with uncomplicated UTI, urine cultures did not change management. Almost all of these patients had a positive leukocyte esterase and were treated with antibiotics, yet approximately 40% of the patients tested did not return positive urine cultures, suggesting that better algorithms for the diagnosis of UTI in the ED are required. Unnecessary treatment with antibiotics is expensive, contributes to the development of multidrug resistant organisms, and exposes the patient to the unnecessary risks of possible allergic reactions, drug interactions and side effects.

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