1.WHAT IS THE SIGNIFICANT DIFFERENCE BETWEEN A SHORT-TERM AND THE USUAL 7-14DAY ANTIBIOTIC TREATMENT?
Answer: There is no significant difference between a short-term and the usual 7-14 day antibiotic treatment. Short- term antibiotic treatment appears to be as effective as 7-14 days in treating UTI. This is supported by the study made by Vogel, T. et al(2004).
Optimal duration of antibiotic therapy
for uncomplicated urinary tract infection in older
women: a double-blind randomized controlled trial
Thomas Vogel, René Verreault, Marie Gourdeau, Michèle Morin, Lise Grenier-Gosselin,Louis Rochette
Vogel, T. et al. made a study which is randomized controlled double-blind noninferiority trial that aims to compare Short term (3-day) and the standard 7-day courses of oral antibiotic therapy using ciprofloxacin in managing uncomplicated symptomatic UTI in older women. Inclusion Criteria: Women with age ranging from 65 years and above; Has uncomplicated symptomatic UTI (lower UTI or Cystisis) that has significant bacterinuria with 1 to 6 possible symptoms like dysuria, frewuency, suprapubic, pain urgency, burning on micturition and other symptoms. Exclusion criteria: Those with signs of pyelonephritis or septic shock; creatinine clearance less than 30ml min–1 1.73 m–2.; use of antibiotics in the preceding 3 days; Have hypersensitivity to fluoroquinolones; structural or functional abnormalities of the urinary tract; residual volume greater than 100 mL; use of an indwelling catheter in the previous six days; in the state of immune deficiency; and with Diabetes mellitus. 183 Participants were randomly assigned to 1 of 2 treatment groups. 93 participants were assigned to treatment 1 (ciprofloxacin 250 mg given orally twice daily for 3 days followed by placebo twice daily for 4 days (the 3-day group). And 90 were assigned to treatment 2 which is given ciprofloxacin 250 mg given orally twice daily for 7 days (the 7-daygroup).
There was no significant difference in rates of bacterial eradication 2 days after the completion of treatment between the Short-term (3-day group) and the 7-day groups(p = 0.16). There were also no significant differences in the rates of reinfection or relapse at 6 weeks after completion of treatment. Improvement in symptoms at 2 days after completion of antibiotic therapy was outstanding in both groups ( 98%of subjects in the 3-day group and 92% in the 7-day group reported disappearance or improvement in at least1 symptom p=0.15. Improvements in specific symptoms were similar for both groups except for the symptom of urgency. The 7 day group had better clinical improvement in the symptom of urgency compare to the 3-day group p=0.05. Adverse events such as drowsiness, loss of appetite, and nausea or vomiting were relatively frequent in both groups during the initial 9-day study period. The mean number of reported adverse events per subject was less for the 3-day group than for the 7-day group p < 0.001.
The results of this randomized controlled double-blind clinical trial made by Vogel, T. Verreault, R. et al. recommend that a 3-day course of an antibiotic with proven efficacy is not inferior to a 7-day course for the treatment of uncomplicated symptomatic UTI in older women. The adverse events are less frequent with the shorter course (3-day) of therapy. Shorter antibiotic treatment (3-day) may also contribute to better compliance and fewer drug interactions and may thus be of particular interest for the older population.
Vogel, T. Verreault, R. et al.(2004). Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. CMAJ;170(4):469-73. Retrieved August 13, 2009 from. http://www.cmaj.ca/cgi/reprint/170/4/469
WHAT PROGRAM/INTERVENTION PREVENTS RECURRENT UTI?
Answer: Interventions to prevent recurrent UTI were prophylactic antibiotics and complementary interventions like probiotics, cranberry, and horseradish.
Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women
Tero Kontiokari, Kaj Sundqvist, M Nuutinen, T Pokka, M Koskela, M Uhari
Kontiokari, T.et al. conducted an open, randomised, controlled trial to assess whether cranberry-lingonberry juice and Lactobacillus GG drink given orally are effective in preventing symptomatic recurrences of urinary tract infection. A total of 150 women participated in the study and were randomly allocated into three groups. The first group (50 participants) received 50 ml of cranberry-lingonberry juice concentrate a day for six months. The second group(50 participants) received 100 ml of Lactobacillus GG drink five days a week for one year. The third group comprised of 50 participants served as an open control group. Participants were women who had a urinary tract infection caused by Escherichia coli and not taking antimicrobial prophylaxis.
During the six months, 8 women in the cranberry group, 19 in the lactobacillus group, and 18 in the control group had at least one episode of urinary tract infection 16%, 39%, and 36% respectively. There is 20% reduction in absolute risk in the cranberry group compared with the control group. The numbers who had a recurrence at 12 months were 12 in cranberry group , 21 in the lactobacillus group, and 19 in the control groups. Recurrence during the study period at 6 months P=0.014 and at 12 months P=0.052 was significantly lower in the cranberry group than in the control group. During follow up, a total of 98 episodes of urinary tract infection occurred: 21 (21%) occurred in the cranberry group; 39 (40%) in the lactobacillus group; and 38 (39%) in the control group.
The results of this open, randomised, controlled trial made by Kontiokari, T.et al. suggest that the daily consumption of 50 ml of cranberry-lingonberry concentrate prevented recurrences by about half of symptomatic urinary tract infection in women, whereas the lactobacillus drink was somehow ineffective. Cranberry-lingonberry concentrate is a natural food product and readily available which means it is a useful way for self administered prevention of urinary tract infection.
Kontiokari, T, Sundqvist, K.et al.(2001). Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 322:1571. Retrieved August 13, 2009 from http://www.bmj.com/cgi/content/full/322/7302/1571?view=long&pmid=11431298#SEC4