ROLE OF SYMPTOMATIC TREATMENT IN COMPARISON TO ANTIBIOTICS IN UNCOMPLICATED URINARY TRACT INFECTIONS

Authors

  • Muhammad Nasir Jamil Ayub medical college
  • Umer Farooq
  • Babar Sultan
  • Raza Muhammad Khan

Abstract

Background: Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. Methods: A randomized control trial (RCT) in 100 women (15–50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. Results: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. Conclusions: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use.Keywords: Uncomplicated; Urinary tract infections; Symptom score; Antibiotics; Symptomatic treatment

References

Gupta K, Hooton T, Naber K, Wullt B, Colgan R, Miller LG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52(5):e103–20.

Schappert SM, Rechtsteiner EA. Ambulatory medical care utilization estimates for 2007. Vital Health Stat 2011;169:1–38.

Baldo BA, Zhao Z, Pham NH. Antibiotic allergy: immunochemical and clinical considerations. Curr Allergy Asthma Rep 2008;8(1):49–55.

Walters MS, Lane MC, Vigil PD, Smith SN, Walk ST, Mobley HL. Kinetics of Uropathogenic Escherichia coli Metapopulation Movement during Urinary Tract Infection. MBio 2012;3(1):e00303–11.

Aypak C, Altunsoy A, Düzgün N. Empiric antibiotic therapy in acute uncomplicated urinary tract infections and fluoroquinolone resistance: a prospective observational study. Ann Clin Microbiol Antimicrob 2009;8:27.

Gobernado M, Valdés L, Alós JI, García-Rey C, Dal-Ré R, García-de-Lomas J, et al. Antimicrobial susceptibility of clinical Escherichia coli isolates from uncomplicated cystitis in women over a 1-year period in Spain. Rev Esp Quimioter 2007;20(1):68–76.

Butler CC, Dunstan F, Heginbothom M, Mason B, Roberts Z, Hillier S, et al. Containing antibiotic resistance decreased antibiotic-resistant coliform urinary tract infections with reduction in antibiotic prescribing by general practices. Br J Gen Pract 2007;57(543):785–92.

Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA, et al. Effectiveness of five different approaches in management of urinary tract infection: randomized controlled trial. BMJ 2010;340:c199.

Bleidorn J, Gágyor I, Kochen MM, Wegscheider K, Eva Pradier EH. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncomplicated urinary tract infection? - Results of a randomized controlled pilot trial. BMC Med 2010;8:30.

Gágyor I, Hummers-Pradier E, Kochen MM, Schmiemann G, Wegscheider K, Bleidorn J. Immediate versus conditional treatment of uncomplicated urinary tract infection - a randomized-controlled comparative effectiveness study in general practices. BMC Infect Dis 2012;12:146.

Head KA. Natural Approaches to Prevention and Treatment of Infections of the Lower Urinary Tract. Altern Med Rev 2008;13(3):227–44.

Ullah F, Malik S, Ahmed J. Antibiotic susceptibility pattern and ESBL prevalence in nosocomial Escherichia coli from urinary tract infections in Pakistan. Afr J Biotechnol 2009;8(16):3921–6.

Ahmed K, Imran. Prevalence and Antibiogram of Uncomplicated Lower Urinary Tract Infections in Human Population of Gilgit, Northern Areas of Pakistan. Pak J Zool 2008;40(4):295–301.

Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomized controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract 2002,52(482):729–34.

Ferry SA, Holm SE, Stenlund H, Lundholm R, Monsen TJ. The natural course of uncomplicated lower urinary tract infection in women illustrated by a randomized placebo controlled study. Scand J Infect Dis 2004;36(4):296–301.

Published

2016-12-10

Most read articles by the same author(s)

<< < 1 2 3 4