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


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


METHODS
We searched MEDLINE (1966-April 2004), EMBASE (1980-January 2003), Cochrane Central Register of Controlled Trials( in The Cochrane Library Issue 1, 2004) and reference lists of retrieved articles


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


METHODS
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).


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 pefloxacin 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.


CONCLUSIONS
Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed nodifference 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.
Albert
X
X
Health Center of Marco Merenciano, Conselleria de Sanidad, Marco Merenciano no 26, Valencia, Spain, 46025. albert_xav@gva.es
Huertas
I
I
Pereiró
I I
II
Sanfélix
J
J
Gosalbes
V
V
Perrota
C
C
D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D014552:Urinary Tract Infections / Q000517:prevention & control*