Antibiotic consumption and time to recovery from uncomplicated urinary tract infection

Background: Randomised trials provide high-quality evidence on the effects of prescribing antibiotics for urinary tract infections (UTI) but may not reflect the effects in those who consume antibiotics. Moreover, they mostly compare different antibiotic types or regimens but rarely included a 'no antibiotic' group. Aim: To estimate the effect of antibiotic consumption, rather than prescription, on time-to-recovery in women with uncomplicated UTI. Design and Settings: Secondary analysis of 14-day observational data from a trial of a point of care test for UTI in primary care. Clinicians treated patients using their own judgment providing immediate, delayed, or no antibiotics. Methods: UTI-symptomatic women who either consumed (n= 333) or did not consume (n= 80) antibiotics during a 14-day follow-up were included. Antibiotic consumption was standardised across participants and grouped into either ≤ 3 or > 3 standardised antibiotic days. To account for confounders, a robust propensity score matching analysis was conducted. Adjusted Kaplan-Meier and Cox proportional hazard models were employed to estimate time-to-recovery and hazard ratios, respectively. Findings: The adjusted median time-to-recovery was 2 days longer among patients who did not consume antibiotics (9 days; 95% CI 7–12) compared to those who did (7 days; 95% CI 7–8). We found no difference between those who consumed ≤ 3 (7 days; 95% CI 7–8) compared to > 3 standardised antibiotic days (7 days; 95% CI 6 – 9). Conclusions: Consuming antibiotics was associated with a reduction in self-reported time-to-recovery, but more antibiotics exposure was not associated with faster recovery in this study.