Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data
Ildikó Gágyor,
Beth Stuart,
Paul Little,
Andreas Kronenberg,
Alastair D Hay,
Michael Moore,
Tim Friede,
Morten Lindbaek,
Thomas Debray,
Ingvild Vik,
Judith Heinz,
Christian Röver,
Ghefar Furaijat,
Yvonne Kaußner,
Eva Hummers,
Stefan Heytens,
Florian Wagenlehner,
Sven Ferry,
Tor Monsen
Affiliations
Ildikó Gágyor
Department of General Practice, Julius-Maximilians-Universitaet Wuerzburg, Wuerzburg, Germany
Beth Stuart
Primary Care and Population Sciences, University of Southampton, Southampton, UK
Paul Little
1 University of Southampton, Southampton, UK
Andreas Kronenberg
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Alastair D Hay
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
Michael Moore
Primary Care Research Centre, University of Southampton Faculty of Medicine, Southampton, UK
Tim Friede
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
Morten Lindbaek
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
Thomas Debray
Smart Data Analysis and Statistics B V, Utrecht, The Netherlands
Ingvild Vik
Department of General Practice, The Antibiotic Centre of Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
Judith Heinz
Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
Christian Röver
Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
Ghefar Furaijat
Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
Yvonne Kaußner
Department of General Practice, Julius Maximilians University Wuerzburg Faculty of Medicine, Wuerzburg, Germany
Eva Hummers
1 Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
Stefan Heytens
Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
Florian Wagenlehner
Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
Sven Ferry
Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
Tor Monsen
Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
Introduction Uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy.Methods and analysis A systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks.Ethics and dissemination The local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases.PROSPERO registration number CRD42019125804.
