Daily antibiotics appeared most effective for recurrent UTIs

Daily antibiotics appeared to be the most effective strategy for combating recurrent urinary tract infections (UTIs), according to a new analysis.

Researchers performed a systematic review of studies on managing UTIs in adult women who had more than 3 UTIs annually. For each management strategy studied by more than 2 adequate clinical trials, the researchers developed a Markov chain Monte Carlo model of recurrent UTI and simulated 2 separate cohorts, one in which patients had 3 UTIs per year and another in which patients had 8 UTIs per year. Treatment efficacy, costs to patients and payers and health-related quality of life were the main model outcomes. The study was published early online Sept. 24 by Clinical Infectious Diseases.

Overall, 5 strategies were addressed by more than 2 adequate clinical trials: daily antibiotic prophylaxis with nitrofurantoin (6 trials), daily prophylaxis with estrogen (5 trials), daily prophylaxis with cranberry (4 trials), acupuncture prophylaxis (2 trials) and symptomatic self-treatment (3 trials). Nitrofurantoin was the most effective method in the 3-UTI-per-year model, reducing the UTI rate to 0.4 per year, and was also the most expensive for payers, costing $821 per year. The other strategies saved the payers money, ranging from $319 per year for estrogen to $502 for acupuncture, and also resulted in cost savings per quality-adjusted life-year (QALY) gained but were not as clinically effective. In the 8-UTI-per-year model, the results were similar except for daily antibiotic prophylaxis, which yielded payer cost savings. Symptomatic self-treatment, meanwhile, was the only strategy to save money for patients ($70 per year) and also was the most favorable for cost per QALY gained (cost savings, $23,260 per QALY gained). Daily antibiotic therapy was the most cost-effective strategy for patients, while acupuncture was the least. In the 8-UTI-per-year model, findings were similar but antibiotic prophylaxis and estrogen prophylaxis also led to cost savings for patients.

The authors noted, among other limitations, that publication bias in the analyzed studies might have led to overestimates of efficacy for some of the therapies and that their model did not account for such factors as multidrug-resistant infections, medication adherence and toxicity. However, they concluded that while antibiotic use was the most effective strategy for recurrent UTIs, daily cranberry pills, daily estrogen and monthly acupuncture were also effective. Most of the regimens resulted in cost savings for payers and for patients, and all of the regimens improved health-related quality of life, with symptomatic self-treatment saving the most per QALY gained.

“Our findings provide clinically meaningful data to guide the physician-patient partnership in determining a preferred method of prevention for this common clinical problem,” the authors wrote.