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symptomatic urinary tract infection (UTI; very low–quality
evidence; Supplementary Table 1).
One randomised controlled trial (RCT) comparing
antibiotic treatment with no treatment of ABU in 673 wom-
en with recurrent symptomatic UTIs found that treatment
increased the risk of subsequent symptomatic UTI episodes
(risk ratio [RR] 0.28, 95% confidence interval [CI] 0.21–0.38;
low-quality evidence; Supplementary Table 1].
A meta-analysis of 11 RCTs involving 2002 pregnant
women with ABU found that antibiotic treatment signifi-
cantly reduced the number of symptomatic UTIs (RR = 0.22,
95% CI 0.12–0.40; very low–quality evidence) compared
with placebo or no treatment (Supplementary Table 1). Data
from six RCTs involving 716 pregnant women showed
benefit for antibiotic treatment in resolving ABU (RR = 2.99,
95% CI 1.65–5.39; very low–quality evidence). Data from
eight RCTs with 1689 women showed reduction in risk of
low birthweight (RR = 0.58, 95% CI 0.36–0.94; very low–
quality evidence) and data from 44 RCTs with 854 women
showed reduced risk of preterm delivery (RR = 0.34, 95% CI
0.18–0.66; low-quality evidence;
Fig. 1A–D). A single recent
trial of higher methodological quality did not find benefit
for antibiotic treatment
[5].
Nine RCTs compared a single dose with the standard
short-course (2–7 d) treatment of ABU in pregnant women
(Supplementary Table 1). Data from nine RCTs with
1268 women showed no difference in the rate of ABU
resolution (RR = 0.97, 95% CI 0.89–1.07; very low–quality
evidence). A meta-analysis of three RCTs with 891 women
found no difference in the rate of symptomatic UTI
(RR = 1.07, 95% CI 0.47–2.47; low-quality evidence) and
data from three RCTs with 814 women showed no difference
in the rate of preterm delivery (RR = 1.16, 95% CI 0.75–1.78;
low-quality evidence). One RCT with 714 women showed a
higher rate of low birthweights using a single dose compared
with short-course treatment (RR = 1.65, 95% CI 1.06–2.57;
moderate-quality evidence). Single-dose treatment was
associated with significantly fewer side effects compared
with short-course treatment, based on the meta-analysis of
data from six RCTs including 458 women (RR = 0.40, 95% CI
0.22–0.72; low-quality evidence;
Fig. 1E–H).
One RCT including 105 patients with diabetes mellitus
demonstrated that eradicating ABU did not reduce the risk
of symptomatic UTI (RR = 1.05, 95% CI 0.66–1.66; low-
quality evidence; Supplementary Table 1).
A meta-analysis of data from three RCTs with 208 post-
menopausal women showed no benefit of antibiotic
treatment compared with placebo or no treatment in
reducing the rate of symptomatic UTI (RR = 0.71, 95% CI
0.49–1.05; very low–quality evidence;
Fig. 2 A) or resolving
ABU (RR = 1.28, 95% CI 0.50–3.24; very low–quality
evidence;
Fig. 2B; Supplementary Table 1).
Meta-analyses of three RCTs with 210 elderly patients
found no reduction in the rate of symptomatic UTI
compared with placebo or no treatment (RR = 0.68, 95%
CI 0.46–1.00; very low–quality evidence;
Fig. 2C; Supple-
mentary Table 1), and data from 328 patients in six RCTs
showed no benefit for the rate of resolution of ABU
(RR = 1.33, 95% CI 0.63–2.79; very low–quality evidence;
Fig. 2D; Supplementary Table 1).
[(Fig._2)TD$FIG]
Fig. 2 – Forest plots on the effect of antibiotic treatment of ABU in postmenopausal women on the rate of (A) symptomatic UTIs and (B) resolution of
ABU; in elderly institutionalised patients on the rate of (C) symptomatic UTI and (D) resolution of ABU; (E) in patients with renal transplants (E) the
rate of symptomatic UTI; and (F) prior to transurethral endourological procedures with resection on the rate of postoperative symptomatic UTIs.
ABU = asymptomatic bacteriuria; CI = confidence interval; UTI = urinary tract infection.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 8 6 5 – 8 6 8
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