title: Effect of pravastatin and fosinopril on recurrent urinary tract infections.
abstract: OBJECTIVE
  Recurrent urinary tract infections (UTIs) are a problem affecting both women and men. Animal experiments and in vitro studies indicate that statins might prevent recurrent UTIs. We assessed the effects of pravastatin on UTI antibiotic prescribing among adults.
  
  
  METHODS
  A post hoc analysis was conducted with data from PREVEND IT, a trial among participants randomized to receive pravastatin, fosinopril or placebo in a 2 × 2 factorial design over 4 years. Trial data were linked to the pharmacy prescription database IADB.nl. The primary outcome was the number of prescriptions with a nitrofuran derivate, a sulphonamide or trimethoprim as a proxy for UTI antibiotic prescribing. Generalized estimating equations were used to estimate the effect on the number of UTI antibiotic prescriptions. Cox regression was used to determine the effect on first and second (recurrent) UTI antibiotic prescriptions.
  
  
  RESULTS
  Of the 864 trial participants, 655 were eligible for analysis. During an average follow-up of 3.8 years, 112 (17%) participants received at least one UTI antibiotic prescription. Intention-to-treat analyses showed that pravastatin was associated with a reduced total number of UTI antibiotic prescriptions (relative risk, 0.43; 95% CI, 0.21-0.88) and occurrence of second UTI antibiotic prescriptions [hazard ratio (HR), 0.25; 95% CI, 0.08-0.77]. No significant effect on occurrence of first UTI antibiotic prescriptions was found (HR, 0.83; 95% CI, 0.57-1.20). Fosinopril was associated with an increased occurrence of first UTI antibiotic prescriptions (HR, 1.82; 95% CI, 1.16-2.88). Combination therapy with fosinopril and pravastatin did not significantly influence the number of UTI antibiotic prescriptions.
  
  
  CONCLUSIONS
  This study suggests that pravastatin can reduce the occurrence of recurrent UTIs. Larger studies among patients with recurrent UTIs are warranted.
authors.affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands. k.b.pouwels@rug.nl
authors.forename: Koen B
authors.initials: KB
authors.lastname: Pouwels
authors.forename: Sipke T
authors.initials: ST
authors.lastname: Visser
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D017328:Fosinopril / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009581:Nitrofurans / Q000627:therapeutic use*; D017035:Pravastatin / Q000008:administration & dosage*; D055502:Secondary Prevention; D014552:Urinary Tract Infections / Q000517:prevention & control*
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D009581:Nitrofurans; D017035:Pravastatin; D017328:Fosinopril