title: Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial.
abstract: BACKGROUND
  Uncomplicated urinary tract infections (UTI) are common in general practice, and are usually treated with antibiotics. Recurrent UTI often pose a serious problem for affected women. Little is known about recurrent UTI and complications when uncomplicated UTI are treated without antibiotics. With ICUTI (Immediate vs. conditional antibiotic use in uncomplicated UTI, funded by BMBF No. 01KG1105) we assessed whether initial symptomatic treatment with ibuprofen could be a treatment alternative for uncomplicated UTI. The presented analysis aims to assess the influence of initial (non-)antibiotic treatment on recurrent UTI rates and pyelonephritis after day 28 up to 6 months after trial participation.
  
  
  METHODS
  This study is a retrospective long-term follow-up analysis of ICUTI patients, surveyed telephonically six months after inclusion in the trial. Recurrent UTI, pyelonephritis or hospitalizations were documented. Statistical evaluation was performed by descriptive and multivariate analyses with SPSS 21.
  
  
  RESULTS
  For the six months follow-up survey, 386 trial participants could be contacted (494 had been included in ICUTI initially, 446 had completed the trial). From day 28 until 6 months after inclusion in ICUTI, 84 recurrent UTI were reported by 80 patients. Univariate and multivariate analyses showed no effect of initial treatment group or antibiotic treatment on number of patients with recurrent UTI. Yet, both analyses showed that patients with a history of previous UTI had significantly more often recurrent UTI. Pyelonephritis occurred in two patients of the antibiotic group and in one patient in the non-antibiotic group.
  
  
  CONCLUSIONS
  This follow-up analysis of a trial comparing antibiotic vs. symptomatic treatment for uncomplicated UTI showed that non-antibiotic treatment has no negative impact on recurrent UTI rates or pyelonephritis after day 28 and up to six months after initial treatment. Thus, a four week follow-up in UTI trials seems adequate.
authors.affiliation: Institute for General Practice, Hannover Medical School, Hannover, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Bleidorn
authors.affiliation: Department of General Practice and Family Medicine, University Medical Center, Goettingen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Hummers-Pradier
authors.affiliation: Institute for Public Health and Nursing Research, Department for Health Services Research, University of Bremen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
authors.affiliation: Institute for General Practice, Hannover Medical School, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Department of General Practice and Family Medicine, University Medical Center, Goettingen, Germany.
authors.forename: Ildikó
authors.initials: I
authors.lastname: Gágyor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy*; D012008:Recurrence; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen
keywords: follow-up; pyelonephritis; recurrent UTI; urinary tract infections