50 diabetic women (mean age 57 years) with asymptomatic bacteriuria were randomized to receive placebo, and 55 (mean age 53.7 years) were randomized to receive trimethoprim-sulfamethoxazole or ciprofloxacin 1. Four weeks after the end of the initial course of therapy, 78 percent of the placebo recipients and 20 percent of the women who received antimicrobial therapy had bacteriuria. After the first six weeks, women in the antimicrobial-therapy group were screened every 3 months and treated if they had bacteriuria. During a mean follow-up of 27 months, 20 women in the placebo group and 23 women in the antimicrobial-therapy group had at least one episode of symtomatic urinary tract infection. The risk of pyelonephritis was 0.28 vs 0.13 per 1 000 days of follow-up, relative risk 2.13, 95% CI 0.81 to 5.62. The women in the antimicrobial-therapy group received 158.2 days of antimicrobial therapy compared with 33.7 days in the placebo group.
A Cochrane review[Abstract] 3 included 9 studies with a total of 1614 subjects. The effectiveness and safety of antibiotics treatment for asymptomatic bacteriuria was assessed in adults of different age, mainly elderly. Treatment varied including nitrofurantoin, trimethoprim, sulpha-trimethoprim, fluoroquinolones, amoxicillin, cefaclor etc. Symptomatic urinary tract infection (UTI) (RR 1.11, 95% CI 0.51 to 2.43; 5 trials, n=1046), complications (RR 0.78, 95% CI 0. 35 to 1.74; 3 trials, n=814), and death (RR 0.99, 95% CI 0.70 to 1.41; 6 trials, n=761) were similar between the antibiotic and placebo or no treatment arms. Antibiotics were more effective for bacteriological cure (RR 2.67, 95% CI 1.85 to 3.85; 9 trials, n=1154) but also more adverse events developed in this group (RR 3.77, 95% CI 1.40 to 10.15; 4 trials, n=921). No decline in the kidney function was observed across the studies; minimal data were available on the emergence of resistant strains after antimicrobial treatment.
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