Review

Women’s health 2016: An update for internists

Pelin Batur, MD, NCMP, CCD, Eleanor Bimla Schwarz, MD, MS, Judith M. E. Walsh, MD, MPH and Kay M. Johnson, MD, MPH
Cleveland Clinic Journal of Medicine December 2016, 83 (12) 905-913; DOI: https://doi.org/10.3949/ccjm.83a.16098

Article Figures & Data

Tables

  • TABLE 1

    Randomized controlled trials of urinary tract infection treatment: Antibiotics vs placebo or delayed antibiotics

    StudyaPatients and treatmentMeasures studiedOutcomes
    Christiaens et al288 women, ages 15-54
    Nitrofurantoin 100 mg or placebo four times a day for 3 days    		Symptoms and urinalysis over 14 daysWomen who reported symptomatic cure (complete relief of symptoms) after 7 days:
     24 (70%) of 40 with nitrofurantoin
     14 (42%) of 38 with placebo
    Women who reported symptomatic improvement (defined as "few symptoms") after 7 days:
     6 (18%) of 40 with nitrofurantoin
     3 (9%) of 38 with placebo
    Bleidorn et al380 women, ages 18-85
    Ibuprofen 400 mg three times a day vs ciprofloxacin 250 mg twice a day for 3 days    		Symptoms and urinalysis over 28 daysSymptomatic improvement and cure after 4 days:
     21 (58.3%) of 36 with ibuprofen
     17 (51.5%) of 33 with ciprofloxacin
    Receiving secondary antibiotic treatment due to ongoing or worsening symptoms by day 9:
     12 (33%) of 36 with ibuprofen
     6 (18%) of 33 with ciprofloxacin (not significant)
    Little et al4309 women, ages 18-70
    Immediate antibiotics vs 48-hour delay vs targeted antibiotics based on symptom severity, dipstick result, or positive midstream urine culture    		Symptom severity at days 2-4
    Rates of antibiotic use    		Immediate antibiotic group had 3.5 days of moderately bad symptoms; most groups were similar; delayed antibiotic group reconsulted less (hazard ratio 0.57, 95% confidence interval 0.36-0.89, P= .014), but had symptoms for 37% longer than the immediate antibiotic group (incident rate ratio 1.37, 95% confidence interval 1.11–1.68, P= .003)
    Rates of antibiotic use:
     Immediate antibiotic group97%
     Symptom severity group90%
     Urine culture group81%
     Urine dipstick group80%
     Delayed antibiotic group77% (P = .011)
    Ferry et al51,143 women, ages 18 and olderSymptoms, bacteriuria, and urine culture over 7 weeksAssociations between symptoms, bacteriuria, and urine culture results were unpredictable
    288 patients received placebo for 7 daysSpontaneous cure rates in the placebo group:
     28% symptom-free after the first week
     37% symptom-free, and no bacteriuria after 5–7 weeks
    Limitation: 39% dropout rate
    Gágyor et al6779 women, ages 18-65Symptoms and urinalysis over 28 days
    Safety data collected every 6 months over 2 years    		See text for more details
    Ibuprofen 400 mg three times a day for 3 days vs a single 3-g dose of fosfomycinTwo-thirds of the women in the ibuprofen group recovered without antibiotic treatment
    Within 28 days, 34% of the ibuprofen group received antibiotic treatment for persistent or worsening symptoms compared with 14% of the fosfomycin group (who received an additional course of antibiotics)
    On days 0–4, patients in the ibuprofen group had more symptoms than those in the fosfomycin group

    • ↵a Participants in these studies were not pregnant.

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