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Garcia-Sangenís A, Morros R, Aguilar-Sánchez M, Medina-Perucha L, Leiva A, Ripoll J, Martínez-Pecharromán M, Bartolomé-Moreno CB, Magallon Botaya R, Marín-Cañada J, Molero JM, Moragas A, Troncoso A, Monfà R, Llor C. Clinical effectiveness and bacteriological eradication of three different Short-COurse antibiotic regimens and single-dose fosfomycin for uncomplicated lower Urinary Tract infections in adult women (SCOUT study): study protocol for a randomised clinical trial. BMJ Open 2021; 11:e055898. [PMID: 34824124 PMCID: PMC8627395 DOI: 10.1136/bmjopen-2021-055898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Uncomplicated lower urinary tract infections (uLUTI) are a common problem in primary care. Current local guidelines recommend the use of a single 3 g dose of fosfomycin. However, most general practitioners (GP) prefer short-course therapies to single-dose therapy. No study has compared head-to-head short-course antimicrobial agents for uLUTIs. Therefore, the aim of this randomised clinical trial is to compare three different short-course antibiotic therapies with a single-dose of fosfomycin for these infections. METHODS AND ANALYSIS This will be a pragmatic, multicentre, parallel group, open trial. Women aged 18 or older and with symptoms of uLUTI and a positive urine dipstick analysis will be randomised to one of the following four groups: a single dose of 3 g of fosfomycin, 2 days of 3 g of fosfomycin o.d., 3 days of pivmecillinam 400 mg three times per day (t.i.d) or 5 days of nitrofurantoin 100 mg t.i.d. A total sample of 1120 patients was calculated. The primary endpoint is clinical effectiveness at day 7, defined as cure of symptoms reported by the patients in a diary including four symptoms: dysuria, urgency, frequency and suprapubic pain, which will be scored on a 4-point severity scale (not present/mild/moderate/severe). Follow-up visits are scheduled at days 7 (phone call), 14 and 28 for assessing evolution. Urine samples will be collected in the three on-site visits and urine cultures performed. If positive, antibiograms for the three antibiotics studied will be performed. Bacterial eradication will be measured at days 14 and 28. ETHICS AND DISSEMINATION The study was approved by the Ethical Board of IDIAP Jordi Gol (reference number: 21/173-AC) and Spanish Agency of Medicines and Medical Devices. The findings of this trial will be disseminated through research conferences and peer-review journals. TRIAL REGISTRATION NUMBER NCT04959331; EudraCT Number: 2021-001332-26. TIME SCHEDULE January 2022 to April 2023.
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Affiliation(s)
- Ana Garcia-Sangenís
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Catalonia, Spain
- UICEC de IDIAP Jordi Gol-Plataforma ScREN, Barcelona, Catalonia, Spain
- Medicines Research Unit, Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Catalonia, Spain
| | - Rosa Morros
- Medicines Research Unit, Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Catalonia, Spain
- Departament de Farmacologia i Terapèutica, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Catalonia, Spain
| | - Mercedes Aguilar-Sánchez
- Microbiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | | | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services; Health Research Institute of the Balearic Islands (IdISBa), Palma De Mallorca, Balearic Islands, Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services; Health Research Institute of the Balearic Islands (IdISBa), Palma De Mallorca, Balearic Islands, Spain
| | | | - Cruz B Bartolomé-Moreno
- Health Research Institute of Aragón; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Aragon, Spain
- Parque Goya Health Centre, Family and Community Care Teaching Unit of Zaragoza Sector I, Zaragoza, Aragon, Spain
| | - Rosa Magallon Botaya
- Health Research Institute of Aragón; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Aragon, Spain
- Arrabal Health Centre, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Jaime Marín-Cañada
- Villarejo de Salvanés Health Centre, Villarejo de Salvané, Madrid, Spain
| | - José M Molero
- Primary Healthcare Centre San Andrés, Comunidad de Madrid Servicio Madrileno de Salud, Madrid, Spain
| | - Ana Moragas
- Universitat Rovira i Virgili, Tarragona, Catalonia, Spain
- Primary Healthcare Centre Jaume I, Tarragona, Spain
| | - Amelia Troncoso
- Primary Care Pharmacy Unit, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Ramon Monfà
- Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Catalonia, Spain
- UICEC de IDIAP Jordi Gol-Plataforma ScREN, Barcelona, Catalonia, Spain
- Medicines Research Unit, Institut de Recerca en Atencio Primaria Jordi Gol, Barcelona, Catalonia, Spain
| | - Carl Llor
- Via Roma Health Centre, Institut de Recerca en Atencio Primaria Jordi Gol, CIBER de Enfermedades Infecciosas, Barcelona, Catalonia, Spain
- Department of Public Health, General Practice, University of Southern Denmark, Odense, Funen, Denmark
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van Hecke O, Wang K, Lee JJ, Roberts NW, Butler CC. Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis. Clin Infect Dis 2017; 65:371-382. [PMID: 28369247 PMCID: PMC5850316 DOI: 10.1093/cid/cix233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/14/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Antibiotic use is the main driver for carriage of antibiotic-resistant bacteria. The perception exists that failure of antibiotic treatment due to antibiotic resistance has little clinical impact in the community. METHODS We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to 15 April 2016 without language restriction. We included studies conducted in community settings that reported patient-level data on laboratory-confirmed infections (respiratory tract, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were reconsultation, further antibiotic prescriptions, symptom duration, and symptom severity. Where possible, we calculated odds ratios with 95% confidence intervals by performing meta-analysis using random effects models. RESULTS We included 26 studies (5659 participants). Clinical response failure was significantly more likely in participants with antibiotic-resistant Escherichia coli urinary tract infections (odds ratio [OR] = 4.19; 95% confidence interval [CI] = 3.27-5.37; n = 2432 participants), Streptococcus pneumoniae otitis media (OR = 2.51; 95% CI = 1.29-4.88; n = 921 participants), and S. pneumoniae community-acquired pneumonia (OR = 2.15; 95% CI = 1.32-3.51; n = 916 participants). Clinical heterogeneity precluded primary outcome meta-analysis for Staphylococcus aureus skin or soft-tissue infections. CONCLUSIONS Antibiotic resistance significantly impacts on patients' illness burden in the community. Patients with laboratory-confirmed antibiotic-resistant urinary and respiratory-tract infections are more likely to experience delays in clinical recovery after treatment with antibiotics. A better grasp of the risk of antibiotic resistance on outcomes that matter to patients should inform more meaningful discussions between healthcare professionals and patients about antibiotic treatment for common infections.
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Affiliation(s)
- Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Joseph J Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Nia W Roberts
- Bodleian Health Care Libraries, Knowledge Centre, Oxford, United Kingdom
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford
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