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Evidence summaries

Antibiotic Prophylaxis after Predisposing Events (Including Postcoital Prophylaxis) for Prevention of Recurrent Cystitis

Prophylaxis after predisposing events (like intercourse) reduces the incidence of recurrent cystitis. Level of evidence: "A"

A topic in Clinical Evidence 1 summarizes the results of 4 RCTs (total n=251) in women with at least 2 episodes of cystitis per year. All four RCTs found that active treatment (co-trimoxazole, nitrofurantoin, or a quinolone) significantly reduced rates of cystitis (p<0.001 in one trial and p<0.0001 in three trials).

A systematic review and meta-analysis 2 included 11 placebo-controlled trials. Postcoital antibiotic prophylaxis was better than placebo (RR 0.15; 95% CI 0.04 to 0.55, 1 trial). 3 studies (n= 596) compared a continuous antibiotic strategy with of a prophylactic antibiotic dose either postintercourse or after UTI-predisposing events (such as micturition, diarrhea, and long walks) and found no difference.

    References

    • Wechsler A. What are the effects of interventions to prevent further recurrence of cystitis in women experiencing at least two infections per year? Recurrent cystitis in non-pregnant women. Clinical Evidence 2005;13:2456-2460.
    • Jent P, Berger J, Kuhn A et al. Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis. Open Forum Infect Dis 2022;9(7):ofac327.[PubMed]

Primary/Secondary Keywords