Oral antibiotics effective to treat severe urinary tract infections

Oct 17 2007

Although doctors routinely use IV antibiotics to cure patients with severe urinary tract infections (UTI), a new review from suggests that oral antibiotics work just as well - from treating acute symptoms to preventing long-term complications of UTI.

In light of this evidence, more doctors might consider using oral antibiotics to treat patients with severe UTI, according to German reviewer Dr. Annette Pohl at University Clinic Freiburg.

This could potentially lead to far fewer hospitalizations, which, besides avoiding disruption for patients and families, could also considerably reduce hospital and related medical costs.

“UTIs cause a significant amount of financial burden on the medical system and families,” said Hiep Nguyen, M.D., director of robotic surgery and research at the Urological Research Center, Children's Hospital Boston. “It costs us a couple of billion dollars a year to treat children with UTIs and that doesn't account for the money parents lose being out of work when their child is hospitalized.”

Pohl cautions that treatment with oral antibiotics requires careful supervision to guarantee compliance and to make sure patients are tolerating oral drugs.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The researchers pooled data from 15 studies of 1,743 patients with severe, symptomatic UTI who received either oral or IV antibiotic treatment. Nine studies involved children, with six studies focusing on children less than one year old. Of the remaining six studies, two comprised women only, including one study of pregnant women.

While UTIs are common infections, affecting an estimated 150 million children and adults worldwide every year, they can spread to the kidneys, causing potentially life-threatening complications. A severe upper UTI, known as pyelonephritis, can trigger high blood pressure and cause kidney scarring, which can lead to kidney failure.

Current standards for treatment differ depending on the severity of the infection. The treatment for uncomplicated lower UTI, affecting primarily the bladder, is generally oral antibiotics, while the standard treatment for more severe upper UTI usually consists of intravenously administered antibiotics and requires a hospital stay.

Yet another approach, known as switch therapy, consists of giving the patient a shot of antibiotics in a doctor's office and then switching to oral antibiotics.

After a year's follow-up, 90 scans showed that 29 percent of the patients had kidney scarring, but the damage occurred equally among patients who had either switch or oral therapy. There was no significant difference in cure, re-infection or relapse rates; in the number of patients with fever after 48 hours; or in the number of patients with adverse effects.

Available oral antibiotics appear potent enough to treat patients with pyelonephritis efficiently, with no difference in long-term outcomes such as kidney scarring, the review concluded.

Nguyen said it might be hard to convince some doctors to prescribe oral therapy for a severe UTI, especially doctors who treat children, since the rate at which children can develop life-threatening complications is often faster than for adults.

“Children get sicker quicker and if bacteria reach the blood they can easily get sepsis,” Nguyen said. “Children are more susceptible to kidney damage and have less resistance to infection. They can worsen in hours. Giving antibiotics intravenously is a practice heavily ingrained in most pediatricians and most physicians will continue to do what they have been taught to do.”

He added, “Modern-day oral antibiotics are just as effective and quickly absorbed, but some people may not believe they can get into the blood fast enough. More studies may need to be done.”