Antibiotics for asymptomatic bacteriuria

Antibiotics appear to be of no clinical benefit for asymptomatic bacteriuria in adults compared with placebo or no treatment, but they appear to cause more adverse events.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment and blinding in half of the sudies).

Summary

A Cochrane review included 9 studies with a total of 1614 subjects. The effectiveness and safety of antibiotics treatment for asymptomatic bacteriuria was assessed in adults of different age, mainly elderly. Treatment varied including nitrofurantoin, trimethoprim, sulpha-trimethoprim, fluoroquinolones, amoxicillin, cefaclor etc. Symptomatic urinary tract infection (UTI) (RR 1.11, 95% CI 0.51 to 2.43; 5 trials, n=1046), complications (RR 0.78, 95% CI 0. 35 to 1.74; 3 trials, n=814), and death (RR 0.99, 95% CI 0.70 to 1.41; 6 trials, n=761) were similar between the antibiotic and placebo or no treatment arms. Antibiotics were more effective for bacteriological cure (RR 2.67, 95% CI 1.85 to 3.85; 9 trials, n=1154) but also more adverse events developed in this group (RR 3.77, 95% CI 1.40 to 10.15; 4 trials, n=921). No decline in the kidney function was observed across the studies; minimal data were available on the emergence of resistant strains after antimicrobial treatment.

Clinical comments

Date of latest search: 24 February 2015

Ədəbiyyat

1. Zalmanovici Trestioreanu A, Lador A, Sauerbrun-Cutler MT et al. Antibiotics for asymptomatic bacteriuria. Cochrane Database Syst Rev 2015;(4):CD009534.