Evidence map›Paper›PMID 30564872›Full record

ArticleInternational urogynecology journal2019

Cross-over data supporting long-term antibiotic treatment in patients with painful lower urinary tract symptoms, pyuria and negative urinalysis.

Sheela Swamy, Anthony S Kupelian, Rajvinder Khasriya, Dhanuson Dharmasena, Hristina Toteva, Tara Dehpour, Linda Collins, Jennifer L Rohn, James Malone-Lee

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in International urogynecology journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
1.3field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 21 citations in OpenAlex.

  1. Article
  2. Article
  3. Observational
  4. Review
  5. Article
  6. A Novel Propidium Monoazide-Based PCR Assay Can Measure Viable UropathogenicFrontiers in cellular and infection microbiology · 2022
    Article
  7. Observational
  8. Review
  9. Article
  10. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Sheela SwamyCentre for Nephrology, Division of Medicine, University College London, London, UK. sheswa@yahoo.com.ORCID 0000-0001-9039-1073
Anthony S KupelianUniversity College London Hospitals NHS Trust, London, UK.
Rajvinder KhasriyaUniversity College London Hospitals NHS Trust, London, UK.
Dhanuson DharmasenaCentre for Nephrology, Division of Medicine, University College London, London, UK.
Hristina TotevaWhittington Hospitals NHS Foundation Trust, London, UK.
Tara DehpourWhittington Hospitals NHS Foundation Trust, London, UK.
Linda CollinsWhittington Hospitals NHS Foundation Trust, London, UK.
Jennifer L RohnCentre for Nephrology, Division of Medicine, University College London, London, UK.
James Malone-LeeCentre for Nephrology, Division of Medicine, University College London, London, UK.
University College London · GBWhittington Hospital · GBUniversity College London Hospitals NHS Foundation Trust · GBYahoo (Spain) · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo measure the effects of an unplanned, sudden cessation of treatment in an unselected group of patients with chronic painful LUTS managed with protracted antimicrobial treatment and to report these observational data collected from a cross-over process. MATERIALS AND

methodsThe imposition of a guideline resulted in the immediate cessation of antibiotic treatment in a cohort of patients with chronic painful LUTS and microscopic pyuria. Patients were assessed before treatment withdrawal, whilst off treatment, and following reinstatement. Outcome measures included a validated symptom score, microscopic enumeration of urinary white cells and uroepithelial cells, and routine urine culture.

resultsThese patients had reported treatment-resistant, painful LUTS for a mean of 6.5 years before treatment at this centre. Treatment was stopped in 221 patients (female = 210; male = 11; mean age = 56 years; SD = 17.81). Sixty-six per cent of women were post-menopausal. After unplanned treatment cessation, 199 patients (90%; female = 188; male = 9) reported deterioration. Eleven patients required hospital care in association with disease recurrence, including acute urinary tract infection (UTI) and urosepsis. Symptom scores increased after cessation and recovered on reinitiating treatment (F = 33; df = 2; p < 0.001). Urinary leucocyte (F = 3.7; df = 2; p = 0.026) and urothelial cells counts mirrored symptomatic changes (F = 6.0; df = 2; p = 0.003). Routine urine culture results did not reflect changes in disease status.

conclusionThese data support the hypothesis that treating painful LUTS associated with pyuria with long-term antimicrobial courses, despite negative urine culture, is effective. The microscopy of fresh unspun, unstained urine to count white cells and epithelial cells offers a valid method of monitoring disease. An unplanned cessation of antibiotic therapy produced a resurgence of symptoms and lower urinary tract inflammation in patients with chronic LUTS, supporting an infective aetiology below the level of routine detection.

Indexed as

Withholding TreatmentAdultAgedAged, 80 and overAnti-Bacterial AgentsChronic DiseaseCross-Over StudiesFemaleHumansLeukocyte CountLower Urinary Tract SymptomsMaleMiddle AgedNitrofurantoinPainPyuriaAnti-Bacterial AgentsNitrofurantoinBladder pain syndromeChronic UTIInterstitial cystitisPainful lower urinary tract symptomsRecurrent UTIUTI guidelines

Identifiers

PMID30564872
PMCPMC6394536
OpenAlexW2905371136

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.