Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial

Gadalla, Amal ORCID: https://orcid.org/0000-0002-3131-725X, Wise, Hannah, Farewell, Daniel ORCID: https://orcid.org/0000-0002-8871-1653, Hughes, Kathryn ORCID: https://orcid.org/0000-0002-8099-066X, Llor, Carl, Moore, Michael, Verheij, Theo J. M., Little, Paul, Butler, Christopher C. and Francis, Nick A. ORCID: https://orcid.org/0000-0001-8939-7312 2022. Antibiotic consumption and time to recovery from uncomplicated urinary tract infection: secondary analysis of observational data from a point-of-care test trial. British Journal of General Practice 72 (725) , pp. 882-890. 10.3399/BJGP.2022.0011

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Abstract

Background Randomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infection (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely include a ‘no antibiotic’ group. Aim To estimate the effect of antibiotic consumption, rather than prescription, on time to recovery in females with uncomplicated UTI. Design and setting Secondary analysis of 14-day observational data from a point-of-care test trial for UTI in primary care in England, the Netherlands, Spain, and Wales, which ran from 2012 to 2014. Clinicians treated patients using their own judgement, providing immediate, delayed, or no antibiotic. Method UTI-symptomatic females who either consumed or did not consume antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤3 or >3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan–Meier and Cox proportional hazard models were employed to estimate time to recovery and hazard ratios, respectively. Results A total of n = 333 females who consumed antibiotics and n = 80 females who did not consume antibiotics were identified and included in the study. The adjusted median time to recovery was 2 days longer among patients who did not consume antibiotics (9 days, 95% confidence interval [CI] = 7 to 12) compared with those who did (7 days, 95% CI = 7 to 8). No difference was found between those who consumed ≤3 (7 days, 95% CI = 7 to 8) compared with >3 standardised antibiotic days (7 days, 95% CI = 6 to 9). Conclusion Consuming antibiotics was associated with a reduction in self-reported time to recovery, but more antibiotics exposure was not associated with faster recovery in this study.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Date of First Compliant Deposit:	9 August 2022
Date of Acceptance:	3 July 2022
Last Modified:	22 May 2023 22:13
URI:	https://orca.cardiff.ac.uk/id/eprint/151824

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