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Given that more than half of all women experience a urinary tract infection (UTI) at some point in their lifetime, advances in treatment and insights into prophylaxis are closely watched. News about a potential new drug and findings related to prevention of recurrent UTI sparked interest, leading to this week's top trending clinical topic. On November 3, GSK announced that they were halting enrollment of a new phase 3 trial in response to substantial positive findings, on the basis of a recommendation by the Independent Data Monitoring Committee (see Infographic).
Gepotidacin is of particular interest given the growing concern about antibiotic resistance, which has become so prevalent that the World Health Organization recently began publishing a list of pathogens that pose the greatest threats. Several of those included (eg, Candida auris) are known to cause UTIs. GSK has announced that it will seek approval for gepotidacin and pursue peer-reviewed publication of study data early next year.
Recurrent UTI represents a significant challenge and is defined as two symptomatic episodes within 6 months or three episodes within 12 months. Experts say that the most important strategy is an individual consultation discussion, which has been shown to lower the frequency of recurrent UTIs through providing information, specifically about causes and behavioral measures. These include things like the recommendation to drink a sufficient, but not excessive, amount of fluids: approximately 1.5 L per day. Only when nonantibiotic therapy fails should antibiotic prophylaxis be considered, with a target of 3-6 months. Before starting therapy, the pathogen should be identified through a urine culture, and resistance testing should be performed. Single-use, postcoital antibiotic prevention may represent an alternative, particularly for women in whom a correlation between recurrent UTIs and sexual intercourse is suspected.
Earlier this year, a study found that a collection of inactivated bacteria, known as MV140, helped prevent recurrent UTI. In a randomized trial of 240 women, 3 months of daily administration resulted in 56% of women avoiding UTIs for 1 year, compared with 25% of women treated with placebo. A longer duration didn't seem to produce a significantly better outcome, as only 58% who received 6 months of treatment were UTI-free. The number of registered adverse events was 48 with 6 months of therapy, 76 with 3 months of therapy, and 81 with placebo.
Concerns about antibiotic use for UTI are common. This has led infectious disease specialists like Roni K. Devlin, MD, MBS, to reiterate that the antibiotic regimen for UTIs should be tailored to "ensure an appropriate bug-drug match" and should follow key recommendations. Devlin points to a recent study involving over 670,000 young women diagnosed with UTI: Almost half received an antibiotic that was inappropriate and more than 75% were prescribed antibiotics for a longer duration than was considered necessary. Devlin specifically advocates for clinical practice guidelines from the Infectious Diseases Society of America (IDSA), which is currently working on updated guidance for acute uncomplicated cystitis and pyelonephritis treatment. IDSA has already updated information regarding the management of asymptomatic bacteriuria. This is a key point of emphasis in avoiding the risk for further antimicrobial resistance, says Devlin, who provided a list of patients who do not require either urinary screening or antibiotic treatment for asymptomatic bacteriuria:
Infants and children
Healthy premenopausal, nonpregnant women
Healthy postmenopausal women
Older, community-dwelling persons who are functionally impaired
Older persons who reside in long-term care facilities
Patients with diabetes
Patients who underwent renal transplant more than 1 month prior
Patients with nonrenal solid organ transplant
Patients with high-risk neutropenia
Patients with spinal cord injury
Patients with indwelling urethral catheters
Patients undergoing elective nonurologic surgery
Patients planning to undergo surgery for an artificial urine sphincter or penile prosthesis implantation
Patients living with implanted urologic devices
Finding the right balance between appropriate treatment and avoidance of further antibiotic resistance is a challenge when it comes to UTIs. This is why news about a potential new drug, and insights into prophylactic strategies, were met with such interest, leading to this week's top trending clinical topic.
Learn more about UTIs.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Ryan Syrek. Trending Clinical Topic: Antibiotics for UTI - Medscape - Nov 18, 2022.