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

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.

scholarly journals Natural history of non-bullous impetigo: A systematic review of time to resolution or improvement without antibiotic treatment

2020 ◽  
pp. bjgp20X714149
Author(s):  
Tammy Hoffmann ◽  
Ruwani Peiris ◽  
Paul Glasziou ◽  
Gina Cleo ◽  
Christopher Del Mar
Keyword(s):  
Systematic Review ◽  
Placebo Group ◽  
Natural History ◽  
Antibiotic Use ◽  
Careful Consideration ◽  
Risk Of Bias ◽  
Symptom Improvement ◽  
Randomised Trials ◽  
Duration Of Symptoms ◽  
History Of

Abstract Background: Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use is not established which hampers informed decision-making about antibiotic use. Aim: To determine the natural history of non-bullous impetigo. Design and Setting: Systematic review. Method: We searched PubMed up to January 2020 and reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials or in single-group prognostic studies not using antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who, at any timepoint, had: i) symptom resolution, ii) symptom improvement, or iii) failed to improve. Adverse event data were also extracted. Results: Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as ‘failure to improve’ ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. Conclusions: While some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.

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

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 12
Author(s):  
Oghenekome A. Gbinigie ◽  
Elizabeth A. Spencer ◽  
Carl J. Heneghan ◽  
Joseph J. Lee ◽  
Christopher C. Butler
Keyword(s):  
Clinical Trials ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Use ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Cochrane Library ◽  
Uncomplicated Urinary Tract Infection ◽  
Cranberry Juice

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.

scholarly journals Systematic Review and Meta-Analysis of Antimicrobial Treatment Effect Estimation in Complicated Urinary Tract Infection

2013 ◽  
Vol 57 (11) ◽  
pp. 5284-5290 ◽  
Author(s):  
Krishan P. Singh ◽  
Gang Li ◽  
Fanny S. Mitrani-Gold ◽  
Milena Kurtinecz ◽  
Jeffrey Wetherington ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Treatment Effect ◽  
Meta Analysis ◽  
Complicated Urinary Tract Infection ◽  
Antimicrobial Treatment ◽  
Uncomplicated Urinary Tract Infection ◽  
Noninferiority Trial

ABSTRACTNoninferiority trial design and analyses are commonly used to establish the effectiveness of a new antimicrobial drug for treatment of serious infections such as complicated urinary tract infection (cUTI). A systematic review and meta-analysis were conducted to estimate the treatment effects of three potential active comparator drugs for the design of a noninferiority trial. The systematic review identified no placebo trials of cUTI, four clinical trials of cUTI with uncomplicated urinary tract infection as a proxy for placebo, and nine trials with reports of treatment effect estimates for doripenem, levofloxacin, or imipenem-cilastatin. In the meta-analysis, the primary efficacy endpoint of interest was the microbiological eradication rate at the test-of-cure visit in the microbiological intent-to-treat population. The estimated eradication rates and corresponding 95% confidence intervals (CI) were 31.8% (26.5% to 37.2%) for placebo, 81% (77.7% to 84.2%) for doripenem, 79% (75.9% to 82.2%) for levofloxacin, and 80.5% (71.9% to 89.1%) for imipenem-cilastatin. The treatment effect estimates were 40.5% for doripenem, 38.7% for levofloxacin, 34.7% for imipenem-cilastatin, and 40.8% overall. These treatment effect estimates can be used to inform the design and analysis of future noninferiority trials in cUTI study populations.

scholarly journals NATURAL HISTORY OF PROTEUS MIRABILIS (PH) URINARY TRACT INFECTION (UTI) IN INFANCY AND CHILDHOOD

1977 ◽  
Vol 11 (4) ◽  
pp. 437-437
Author(s):  
Abdul J Khan ◽  
Ramesh C Ubriani ◽  
Edith Bombach ◽  
Harold Ratner ◽  
Hugh E Evans
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Natural History ◽  
Tract Infection ◽  
Proteus Mirabilis ◽  
Infancy And Childhood ◽  
History Of
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