UK data supports long-term antibiotic treatment for people with chronic painful lower urinary tract symptoms

A research paper published today in the International Urogynecology Journal shows that UK study data from 210 female and 11 male patients supports long-term antibiotic treatment for people with chronic painful lower urinary tract symptoms (LUTS), pyuria & negative standard UTI tests.

The paper measured the effects of an unplanned and sudden end to treatment of patients with chronic UTI.

When the LUTS clinic at the Whittington hospital in north London closed and patients had their treatment withdrawn most got sicker.

Of a group of 221 patients

  • 199 patients reported a deterioration of their condition
  • 11 patients required hospital care.

Abstract

Purpose:
To 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 methods The 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. Results These 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.

Conclusion:
These 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.

Read the research (opens as PDF)