Antibiotics Best, But Not Only Way to Treat Recurrent UTIs

Cranberry pills, estrogen therapy, and acupuncture also show benefit.
Cranberry pills, estrogen therapy, and acupuncture also show benefit.

Daily antibiotic use came out on top when compared with several other strategies for managing recurrent urinary tract infections (UTIs), but daily cranberry pills, daily estrogen therapy, and acupuncture also had good showings of cost-effectiveness.

After conducting a systematic literature review focusing on the management of women experiencing at least three UTIs per year, a team led by Loren G. Miller, MD, MPH, of the Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center (LABioMed), developed a model of recurrent UTI for each management strategy for which at least two adequate trials had been published.

As the researchers described in Clinical Infectious Diseases (2014;58[2]:147-160), they simulated a cohort that experienced three UTIs per year and a secondary cohort that experienced eight UTIs per year to learn more about treatment efficacy, patient and payer cost, and health-related quality of life.

Five strategies for the prevention and management of recurrent UTIs were analyzed: daily antibiotic (nitrofurantoin) prophylaxis, daily estrogen prophylaxis, daily cranberry prophylaxis, acupuncture prophylaxis, and symptomatic self-treatment. The nitrofurantoin option proved to be the most effective as well as the most expensive to the payer in the model of three UTIs per year: Antibiotic therapy reduced the UTI rate to 0.4 per year, at an annual cost to the payer of $821.

The acupuncture recurrence rate was 0.7 per year. The use of cranberry pills brought the recurrence rate to 1.1 per year, as did estrogen therapy. Symptomatic self-treatment did not reduce recurrence rates but was associated with the highest quality of life of all management strategies (all regimens improved this measure).

Whereas insurance providers saved money on all five approaches, all but self-diagnosis and treatment increased out-of-pocket costs for patients, from a mean of $140 per year for antibiotics to a mean of $946 per year for acupuncture, the latter of which was often paid wholly or mostly by the patient. (In contrast, insurance often covered all or part of the costs of antibiotic therapy.)

“This study provides comparisons of prevention approaches so women can knowledgeably discuss with their providers the most appropriate way for them to manage recurrent urinary tract infections,” Dr. Miller affirmed in a statement issued by LABioMed. “Because patient preferences are very diverse, we laid out the benefits and costs of each approach to help the patient and provider choose an approach that best suits the patient's lifestyle and preferences.”

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