Doctors from the UK’s only centre specialising in the treatment of chronic urinary tract infections (UTIs) say long-term antibiotics can successfully induce disease remission, even in patients with mid-stream urine (MSU) cultures.
Over a 10-year period, the research team collected data on 624 women with chronic lower urinary tract symptoms (LUTS) and pyuria who were treated at the Lower Urinary Tract Symptoms Clinic at Whittington Hospital. The outpatient facility in north London is the only clinic in the United Kingdom specialising in treating chronic UTIs.
Prior to presentation, the mean duration of symptoms was 6.5 years. Only 16% of MSU cultures submitted were positive. Patients were treated with a full dose of first-line, narrow spectrum oral antibiotics such as cefalexin, nitrofurantoin or trimethoprim, along with the urinary antiseptic methenamine hippurate (Hiprex). All patients who completed treatment were also given back-up antibiotics to use at home at the first indication of symptom resurgence. Mean treatment length was 383 days.
Treatment was associated with a reduction in total LUTS (P=.0001), 24-hour frequency (P=.0001), urinary urgency (P=.0001), lower urinary tract pain (P=.0001), voiding symptoms (P=.002) and pyuria (P=.0001). Overall, 64% of women reported that their symptoms were very much better, with another 20% reporting that they were much better. In many cases, it took more than a year and more than 1 cycle of treatment to resolve symptoms.
A total of 475 adverse events was recorded during 273,762 treatment days, only one of which was considered to be serious, and no increase in the proportion of resistant bacterial isolates was observed.
