Delayed and Non-Antibiotic Therapy for Urinary Tract Infections: A Literature Review

Area of Science:

• Urology
• Infectious Diseases
• Pharmacology

Background:

• Urinary tract infections (UTIs), particularly uncomplicated cystitis, are a leading cause of antibiotic prescriptions in women.
• Current treatment paradigms often involve immediate antibiotic prescribing, contributing to antibiotic overuse.
• Alternative strategies like delayed prescribing and non-antibiotic therapies are being explored.

Purpose of the Study:

• To review existing literature on delayed antibiotic prescribing and non-antibiotic treatments for uncomplicated cystitis.
• To evaluate the efficacy and safety of these alternatives compared to immediate antibiotic prescriptions.
• To inform antibiotic stewardship interventions in outpatient settings.

Main Methods:

• A comprehensive literature search was conducted across PubMed, Google Scholar, and Web of Science.
• Included studies were clinical trials comparing immediate antibiotics to delayed antibiotics, placebo, or non-antimicrobial symptomatic treatments.
• A total of 13 relevant articles were analyzed and categorized based on comparator groups.

Main Results:

• Delayed antibiotic therapy and placebo showed lower rates of early microbiologic and clinical cure compared to immediate antibiotics.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) demonstrated symptomatic resolution rates of 70-83% by day 7.
• Delayed or placebo therapies achieved 26-75% symptomatic resolution by day 7, with potential for delayed symptom improvement.

Conclusions:

• Delayed antibiotic prescribing and NSAIDs are plausible alternatives to immediate antibiotics for uncomplicated cystitis in non-pregnant women.
• These strategies have the potential to decrease overall antibiotic use in primary care.
• Careful consideration of study methodologies can aid in developing effective antibiotic stewardship programs.