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BMC Pregnancy and Childbirth

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Open Access 01-12-2018 | Research article

A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy

Authors: Flavia Ghouri, Amelia Hollywood, Kath Ryan

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Abstract

Background

Urinary tract infections (UTIs) are common in pregnancy and account for the highest proportion of primary care antibiotic prescriptions issued to pregnant women in the UK. It is well known that antibiotic use is associated with increased antimicrobial resistance and therefore measures to minimise antibiotic use for UTI prevention have been studied. The efficacy and safety of these measures in pregnancy have not been addressed and therefore the aim of this study was to systematically review the literature to identify and evaluate potential measures to prevent UTIs in pregnant women.

Methods

Ten databases (EMBASE, AMED, BNI, CINAHL, Medline, PubMed, PsycINFO, Cochrane Trials, Scopus and Science Direct) were systematically searched in July 2017 for studies reporting non-antibiotic measures to prevent UTIs in pregnancy. The terms (“urinary tract infection” or UTI or bacteriuria or cystitis) AND (prevention) AND (pregnan*) were used. The quality of the publications was appraised using the Critical Appraisal Skills Programme (CASP) checklists for cohort study, case-control study and randomised controlled trial. The results were synthesised using a textual narrative approach.

Results

Search results yielded 3276 publications and after reviewing titles and removing duplicates, 57 full text articles were assessed for eligibility and eight were included in the review. Five different approaches (hygiene measures, cranberry juice, immunisation, ascorbic acid and Canephron® N) have been identified, all of which are reported to be safe in pregnancy.

Conclusion

The quality of the evidence varied considerably and only hygiene measures were supported by evidence to be recommended in practice. Future work needs to concentrate on strengthening the evidence base through improved design and reporting of studies with a focus on immunisation, ascorbic acid and Canephron® N.

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Petersen I, Gilbert R, Evans S, Ridolfi A, Nazareth I. Oral antibiotic prescribing during pregnancy in primary care: UK population-based study. J Antimicrob Chemother. 2010;65:2238–46. https://doi.org/10.1093/jac/dkq307.CrossRefPubMed

Johnson EK, Wolf JS, Edward K, editors. Urinary tract infections in pregnancy: Medscape; 2016. https://emedicine.medscape.com/article/452604-overview. Accessed 20 Nov 2017

Bonkat G, Pickard R, Bartoletti R, Bruyère F, Geerlings S, Wagenlehner F, Wult B. Guideline: urological infections. Eur Assoc Urol. 2017; http://uroweb.org/guideline/urological-infections. Accessed 20 Nov 2017

Cunningham FG, Morris GB, Mickal A. Acute pyelonephritis of pregnancy: a clinical review. Obstet Gynecol. 1973;42(1):112–7.PubMed

Nicolle LE. Asymptomatic bacteriuria when to screen and when to treat. Infect Dis Clin N Am. 2003;17:367–94. https://doi.org/10.1016/S0891-5520(03)00008-4.CrossRef

Scottish Intercollegiate Guidelines Network (SIGN). Management of suspected bacterial urinary tract infection in adults. 2012. (SIGN publication no. 88). http://www.sign.ac.uk/assets/sign88.pdf. Accessed 20 Nov 2017.

Fair RJ, Tor Y. Antibiotics and bacterial resistance in the 21st century. Perspect Med Chem. 2014;6:25–64. https://doi.org/10.4137/PMC.S14459.

O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Rev Antimicrob Resist. 2016; https://amr-review.org. Accessed 20 Nov 2017

Hillier S, Roberts Z, Dunstan F, Butler C, Howard A, Palmer S. Prior antibiotics and risk of antibiotic-resistant community-acquired urinary tract infection: a case–control study. J Antimicrob Chemother. 2007;60(1):92–9. https://doi.org/10.1093/jac/dkm141.CrossRefPubMed

10.

Rizvi M, Khan F, Shukla I, Malik A, Shaheen. Rising prevalence of antimicrobial resistance in urinary tract infections during pregnancy: necessity for exploring newer treatment options. J Lab Physicians. 2011;3(2):98–103. https://doi.org/10.4103/0974-2727.86842.CrossRefPubMedPubMedCentral

11.

Public Health England. Managing common infections: guidance for primary care. 2017. https://www.gov.uk/government/publications/managing-common-infections-guidance-for-primary-care. Accessed 10 Apr 2018.

12.

Winstanley TG, Limb DI, Eggington R, Hancock F. A 10 year survey of the antimicrobial susceptibility of urinary tract isolates in the UK: the Microbe Base project. J Antimicrob Chemother. 1997;40:591–4. https://doi.org/10.1093/jac/dkg028. CrossRefPubMed

13.

Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096. https://doi.org/10.1136/bmj.c2096.CrossRefPubMed

14.

Towers CV, Carr MH, Padilla G, Asrat T, Beach L. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol. 1998;179(4):879–83. https://doi.org/10.1203/00006450-199804001-00946.CrossRefPubMed

15.

Mercer BM, Carr TL, Beazley DD, Crouse DT, Sibai BM. Antibiotic use in pregnancy and drug-resistant infant sepsis. Am J Obstet Gynecol. 1999;181(4):816–21. https://doi.org/10.1016/S0002-9378(99)70307-8.CrossRefPubMed

16.

Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and risk of spontaneous abortion. Can Med Assoc J. 2017;189(17):E625–33. https://doi.org/10.1503/cmaj.161020.CrossRef

17.

Ailes EC, Gilboa SM, Gill SK, Broussard CS, Crider KS, Berry RJ, et al. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. Birth Defects Res A Clin Mol Teratol. 2016;106(11):940–9. https://doi.org/10.1002/bdra.23570.CrossRefPubMedPubMedCentral

18.

Kenyon S, Pike K, Jones D, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet. 2008;372(9646):1319–27. https://doi.org/10.1016/S0140-.CrossRefPubMed

19.

Department of Health, Department for Environment Food and Rural Affairs. UK five year antimicrobial resistance strategy 2013 to 2018. 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf. Accessed 18 Dec 2017.

20.

Beerepoot MAJ, Geerlings SE, Van Haarst EP, Mensing Van Charante N, Ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol. 2013;190:1981–9.CrossRefPubMed

21.

Critical Appraisal Skills Programme. CASP Cohort Study Checklist. 2017. http://www.casp-uk.net/casp-tools-checklists. Accessed 15 Dec 2017.

22.

Critical Appraisal Skills Programme. CASP Case Control Study Checklist. http://www.casp-uk.net/casp-tools-checklists. Accessed 15 Dec 2017.

23.

Critical Appraisal Skills Programme. CASP Randomised Controlled Trial Checklist. 2017. http://www.casp-uk.net/casp-tools-checklists. Accessed 15 Dec 2017.

24.

Badran YA, El-Kashef TA, Abdelaziz AS, Ali MM. Impact of genital hygiene and sexual activity on urinary tract infection during pregnancy. Urol Ann. 2015;7(4):478–81. https://doi.org/10.4103/0974-7796.157971.CrossRefPubMedPubMedCentral

25.

Amiri FN, Rooshan MH, Ahmady MH, Soliamani MJ. Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East Mediterr Health J. 2009;15(1):104–10.PubMed

26.

Elzayat MA, Barnett-vanes A, Farag M, Dabour E, Cheng F. Prevalence of undiagnosed asymptomatic bacteriuria and associated risk factors during pregnancy : a cross-sectional study at two tertiary centres in Cairo, Egypt. BMJ Open. 2017:1–7. https://doi.org/10.1136/bmjopen-2016-013198.

27.

Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol. 2008;180(4):1367–72. https://doi.org/10.1016/j.juro.2008.06.016.CrossRefPubMedPubMedCentral

28.

Essadi F, Elmehashi MO. Efficacy of cranberry juice for the prevention of urinary tract infections in pregnancy [abstract]. Poster Session. J Matern Fetal Neonatal Med. 2010;23(sup1):378. https://doi.org/10.3109/14767051003802503.

29.

Baertschi R, Balmer JA, Eduah SB, Liechti A, Lurie D, Schams H. Bacterial extract for the prevention of recurrent urinary tract infections in pregnant women: a pilot study. Int J. Immunotherapy. 2003;19(1):25–31.

30.

Grischke EM, Rüttgers H. Treatment of bacterial infections of the female urinary tract by immunization of the patients. Urol Int. 1987;42:338–41. https://doi.org/10.1159/000281988.CrossRefPubMed

31.

Ochoa-Brust GJ, Fernández AR, Villanueva-Ruiz GJ, Velasco R, Trujillo-Hernández B, Vásquez C. Daily intake of 100 mg ascorbic acid as urinary tract infection prophylactic agent during pregnancy. Acta Obstet Gynecol Scand Suppl. 2007;86(7):783–7. https://doi.org/10.1080/00016340701273189. CrossRef

32.

Ordzhonikidze N, Yemelyanova A, Petrova S. Prevention and treatment of complications in pregnant women and peurperas with urinary tract diseases. Akush Ginekol (Mosk). 2009;6:41–5.

33.

Flower A, Bishop FL, Lewith G. How women manage recurrent urinary tract infections: an analysis of postings on a popular web forum. BMC Fam Pract. 2014;15:162. https://doi.org/10.1186/1471-2296-15-162.CrossRefPubMedPubMedCentral

34.

Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10 https://doi.org/10.1002/14651858.CD001321.pub5.

35.

Dugoua J-J, Seely D, Perri D, Mills E, Koren G. Safety and efficacy of cranberry (vaccinium macrocarpon) during pregnancy and lactation. Can J Clin Pharmacol. 2008;15(1):e80–6.PubMed

36.

Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of cranberry in pregnancy – the Norwegian mother and child cohort study. BMC Complement Altern Med. 2013;13:345. https://doi.org/10.1186/1472-6882-13-345.CrossRefPubMedPubMedCentral

37.

Bartoletti R, Cai T, Wagenlehner FM, Naber K, Bjerklund Johansen TE. Treatment of urinary tract infections and antibiotic stewardship. Eur Urol. 2016;15(4):81–7. https://doi.org/10.1016/j.eursup.2016.04.003.CrossRef

38.

Naber KG. Efficacy and safety of the phytotherapeutic drug Canephron® N in prevention and treatment of urogenital and gestational disease: review of clinical experience in Eastern Europe and Central Asia. Res Rep Urol. 2013;5:39–46. https://doi.org/10.2147/RRU.S39288. PubMedPubMedCentral

39.

Medved VI, Islamova EV. To the question on safety of the preparation Canephron N in the obstetric practice. Med Asp Women’s Health. 2009;4:32–5.

40.

Medved V. Safety of Canephron® N for the treatment of urinary tract infections in the first trimester of pregnancy. Clin Phytoscience. 2015;1:11. https://doi.org/10.1186/s40816-015-0012-1.CrossRef

Title: A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy
Authors: Flavia Ghouri
Amelia Hollywood
Kath Ryan
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-018-1732-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A systematic review of non-antibiotic measures for the prevention of urinary tract infections in pregnancy

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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