Intervention Review

Antibiotics for preventing recurrent urinary tract infection in non-pregnant women

  1. Xavier Albert1,*,
  2. Isabel Huertas2,
  3. Inmaculado Pereiro3,
  4. José Sanfélix4,
  5. Victoria Gosalbes5,
  6. Carla Perrotta6

Editorial Group: Cochrane Renal Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 21 MAR 2007

DOI: 10.1002/14651858.CD001209.pub2

Database Title

Additional Information

How to Cite

Albert X, Huertas I, Pereiro I, Sanfélix J, Gosalbes V, Perrotta C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001209. DOI: 10.1002/14651858.CD001209.pub2.

Author Information

  1. 1

    Valencian Agency of Health, Health Center of Montcada. Department 6, Valencia, Spain

  2. 2

    Conselleria de Sanidad, Surveillance and epidemiologic control unit, Valencia, Valencia, Spain

  3. 3

    Unidad de Investigacion Trinitat, Direccion de Atencion primaria Area 4, Valencia, Spain

  4. 4

    Conselleria de Sanidad, Health Center of Nazaret, Valencia, Spain

  5. 5

    EVES-Escuela Valenciana de Estudios para la Salud, Teaching Unit of Family Practice, Valencia, Spain

  6. 6

    UCD School of Public Health and Population Sciences, Woodview House, Dublin, Ireland

*Xavier Albert, Health Center of Montcada. Department 6, Valencian Agency of Health, Av. Mediterraneo s/n, Montcada, Valencia, 46113, Spain. albert_xav@gva.es.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Urinary tract infection (UTI) is a common health care problem. Recurrent UTI (RUTI) in healthy non-pregnant women is defined as three or more episodes of UTI during a twelve month period. Long-term antibiotics have been proposed as a prevention strategy for RUTI.

Objectives

To determine the efficacy (during and after) and safety of prophylactic antibiotics used to prevent uncomplicated RUTI in adult non-pregnant women.

Search methods

We searched MEDLINE (from 1966), EMBASE (from 1980), Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library) and reference lists of retrieved articles.

Selection criteria

Any published randomised controlled trial where antibiotics were used as prophylactic therapy in RUTI.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI).

Main results

Nineteen studies involving 1120 women were eligible for inclusion.
Antibiotic versus antibiotic (10 trials, 430 women): During active prophylaxis the rate range of microbiological recurrence patient-year (MRPY) was 0 to 0.9 person-year in the antibiotic group against 0.8 to 3.6 with placebo. The RR of having one microbiological recurrence (MR) was 0.21 (95% CI 0.13 to 0.34), favouring antibiotic and the NNT was 1.85. For clinical recurrences (CRPY) the RR was 0.15 (95% CI 0.08 to 0.28). The NNT was 1.85. The RR of having one MR after prophylaxis was 0.82 (95% CI 0.44 to 1.53). The RR for severe side effects was 1.58 (95% CI 0.47 to 5.28) and for other side effects the RR was 1.78 (CI 1.06 to 3.00) favouring placebo. Side effects included vaginal and oral candidiasis and gastrointestinal symptoms.

Antibiotic versus antibiotic (eight trials, 513 women): These trials were not pooled. Weekly perfloxacin was more effective than monthly. The RR for MR was 0.31(95% CI 0.19 to 0.52). There was no significant difference in MR between continuous daily and postcoital ciprofloxacin.

Authors' conclusions

Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed no difference between groups. There were more adverse events in the antibiotic group. One RCT compared postcoital versus continuous daily ciprofloxacin and found no significant difference in rates of UTIs, suggesting that postcoital treatment could be offered to woman who have UTI associated with sexual intercourse.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Non-pregnant women who have had several urinary tract infections are less likely to have another infection if they take antibiotics for six to 12 months

Urinary tract infections (UTI) are infections of the bladder and kidneys. They can cause vomiting, fever and tiredness, and occasionally kidney damage. The review found that non-pregnant women who had two or more UTIs in the past year had less chance of having a further UTI if given a six to 12 month treatment with antibiotics. The most commonly reported side effects are digestive problems, skin rash and vaginal irritation. More research is needed determine the optimal duration for antibiotic treatment.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

非懷孕婦女使用抗生素預防復發性泌尿道感染

泌尿道感染是一種常見健康照護的問題，在健康非懷孕婦女，復發性泌尿道感染被定義為在12月期間發生 3 次或更多次感染，長期抗生素治療被認為可預防復發性泌尿道感染。

目標

決定在成年非懷孕婦女使用預防性抗生素治療的效果 (治療期間及治療之後) 及安全性。

搜尋策略

我們調查MEDLINE (從1996年) ，EMBASE (從1980) ，Cochrane Contral Registor of Controlled Trial及相關文章的參考文獻，最近搜尋日期為2007年03月。

選擇標準

任何發表有關使用抗生素治療復發性的臨床隨機對照試驗均被選入。

資料收集與分析

兩位研究者分別獨立的評估試驗品質並摘錄資料，使用隨機效果模式 (random effects model) 來做統計分析，相關的結果以95% 的信賴區間 (CI) 預後的相對風險性 (RR) 來呈現。

主要結論

共有19個研究包括1120婦女，抗生素比抗生素 (10個試驗，430個婦女) ：在積極使用預防性抗生素治療期間，使用抗生素組的微生物復發病患年 (MRPY) 為 (0 – 0.9) 病人年，而對照組則為0.8 – 3.6病患年。曾有一次微生物復發的相對風險為0.21 (95% 信賴區間0.13 – 0.34) ，傾向使用抗生素治療及NNT為1.85，在使用預防性抗生素後，曾有一次微生物復發的相對風險為0.82 (95% 信賴區間0.44 – 1.53) 。產生嚴重副作用的相對風險為1.58 ((95% 信賴區間0.47 – 5.28) ，其他副作用的相對風險為1.78。副作用包括陰道、口腔黴菌感染及腸胃道的症狀，抗生素比抗生素 (8個試驗，513婦女) ：這些試驗沒有被整合，每星期使用一次的Pefloxacin比每個月使用一次的效果佳。微生物復發的相對風險為0.31 (95% 信賴區間0.19 – 0.52) ，每天持續性的Ciprofloxacin治療與性交後給與Ciprofloxacin治療比較下，對於微生物復發並無差別。

作者結論

在預防性治療期間，持續預防性抗生素使用 (維持6 – 12月) 與對照組比較之下可有效性降低泌尿道感染。在預防性治療之後，有二個研究顯示這二組病患無差異。使用預防性抗生素組有更多不利的影響，有一隨機對照的研究，比較性交後與每天持續給與Ciprofloxacin，結果顯示對於泌尿道感染的婦女，可用性交後給藥的方法預防泌尿道感染。

翻譯人

本摘要由馬偕醫院郭馨仁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

成年非懷孕婦女，如果使用持續預防性抗生素使用 (維持6 – 12月) ，可以減少之後泌尿道感染。泌尿道感染是膀胱和腎臟的感染，可導致嘔吐，發燒，疲倦，偶爾造成腎臟受到傷害。這總結發現，成年非懷孕婦女，如果在過去一年內，有二到三次泌尿道感染，使用持續預防性抗生素使用 (維持6 – 12月) ，可以減少之後泌尿道感染的機會。最常見的副作用:腸胃道的症狀，皮膚紅疹，陰道黴菌感染刺激。需要更多的研究報告，來決定使用抗生素的時間。

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