Skip to main content
Top
Published in: Trials 1/2019

Open Access 01-12-2019 | Antibiotic | Study protocol

Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? Protocol for a feasibility study

Authors: Oghenekome Gbinigie, Julie Allen, Anne-Marie Boylan, Alastair Hay, Carl Heneghan, Michael Moore, Nicola Williams, Chris Butler

Published in: Trials | Issue 1/2019

Login to get access

Abstract

Background

Consultations in primary care for symptoms of urinary tract infections (UTIs) are common and patients are frequently treated with antibiotics. Given increasing antimicrobial resistance, there has been interest in non-antibiotic treatment options for common infections. One such option is the use of cranberry extract to treat symptoms attributable to UTIs.

Methods

A target of 45 women consulting in primary care, with symptoms suggestive of an uncomplicated UTI for whom the practitioner would normally prescribe antibiotics, will be randomised to receive one of three treatment approaches: (1) immediate prescription for antibiotics; (2) immediate prescription for antibiotics plus a 7-day course of cranberry capsules and (3) cranberry capsules plus a delayed prescription for antibiotics to be used in case their symptoms do not get better, or get worse. Follow-up will be by daily rating of symptoms and recording of treatments used for 2 weeks in an online symptom diary. Interviews will be conducted with around 10–15 study participants, as well as with around 10–15 women who have experienced a UTI but have not been approached to take part in the study. Both groups will be asked about their experience of having a UTI, their thoughts on non-antibiotic treatments for UTIs and their thoughts on, or experience of, the feasibility trial. The primary objective is to assess the feasibility of undertaking a full trial in primary care of the effectiveness of cranberry extract to reduce antibiotic use for symptoms of acute uncomplicated UTI. The secondary objective is to conduct a preliminary assessment of the extent to which cranberry might reduce antibiotic use and symptom burden.

Discussion

This feasibility study with embedded interviews will inform the planning and sample size calculation of an adequately powered trial to definitively determine whether cranberry helps to alleviate the symptoms of acute uncomplicated UTIs in women and whether it can safely reduce antibiotic use.

Trial registration

ISRCTN registry, ID: 10399299. Registered on 24 January 2019.
Appendix
Available only for authorised users
Literature
1.
go back to reference Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract. 2015;65(639):e702–e7.CrossRef Butler CC, Hawking MK, Quigley A, McNulty CA. Incidence, severity, help seeking, and management of uncomplicated urinary tract infection: a population-based survey. Br J Gen Pract. 2015;65(639):e702–e7.CrossRef
2.
go back to reference Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.CrossRef Goossens H, Ferech M, Vander Stichele R, Elseviers M, Group EP. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579–87.CrossRef
3.
go back to reference Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36(6):697–705.CrossRef Alanis AJ. Resistance to antibiotics: are we in the post-antibiotic era? Arch Med Res. 2005;36(6):697–705.CrossRef
4.
go back to reference Gágyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544.CrossRef Gágyor I, Bleidorn J, Kochen MM, Schmiemann G, Wegscheider K, Hummers-Pradier E. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: randomised controlled trial. BMJ. 2015;351:h6544.CrossRef
5.
go back to reference Kronenberg A, Bütikofer L, Odutayo A, Mühlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017;359:j4784.CrossRef Kronenberg A, Bütikofer L, Odutayo A, Mühlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017;359:j4784.CrossRef
6.
go back to reference Vik I, Bollestad M, Grude N, Bærheim A, Damsgaard E, Neumark T, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial. PLoS Med. 2018;15(5):e1002569.CrossRef Vik I, Bollestad M, Grude N, Bærheim A, Damsgaard E, Neumark T, et al. Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial. PLoS Med. 2018;15(5):e1002569.CrossRef
7.
go back to reference Moore M, Trill J, Simpson C, Webley F, Radford M, Stanton L, et al. Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. 2019. Moore M, Trill J, Simpson C, Webley F, Radford M, Stanton L, et al. Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial. 2019.
8.
go back to reference Howell AB, Reed JD, Krueger CG, Winterbottom R, Cunningham DG, Leahy M. A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. Phytochemistry. 2005;66(18):2281–91.CrossRef Howell AB, Reed JD, Krueger CG, Winterbottom R, Cunningham DG, Leahy M. A-type cranberry proanthocyanidins and uropathogenic bacterial anti-adhesion activity. Phytochemistry. 2005;66(18):2281–91.CrossRef
10.
go back to reference Papas P, Brusch C, Ceresia GJ. Cranberry juice in the treatment of urinary tract infections. Southwest Med. 1966;47(1):17.PubMed Papas P, Brusch C, Ceresia GJ. Cranberry juice in the treatment of urinary tract infections. Southwest Med. 1966;47(1):17.PubMed
11.
go back to reference Panchev P, Slavov C, Mladenov D, Georgiev M, Yanev K, Paskalev E, et al. A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis. Akush Ginekol (Sofiia). 2012;51(7):49–55. Panchev P, Slavov C, Mladenov D, Georgiev M, Yanev K, Paskalev E, et al. A multicenter comparative observation on the effectiveness and the rapidness of the effect of Cystostop Rapid versus antibiotic therapy in patients with uncomplicated cystitis. Akush Ginekol (Sofiia). 2012;51(7):49–55.
12.
go back to reference Little P, Moore M, Turner S, Rumsby K, Warner G, Lowes J, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010;340:c199.CrossRef Little P, Moore M, Turner S, Rumsby K, Warner G, Lowes J, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010;340:c199.CrossRef
13.
go back to reference Trill J, Simpson C, Webley F, Radford M, Stanton L, Maishman T, et al. Uva-ursi extract and ibuprofen as alternative treatments of adult female urinary tract infection (ATAFUTI): study protocol for a randomised controlled trial. Trials. 2017;18(1):421.CrossRef Trill J, Simpson C, Webley F, Radford M, Stanton L, Maishman T, et al. Uva-ursi extract and ibuprofen as alternative treatments of adult female urinary tract infection (ATAFUTI): study protocol for a randomised controlled trial. Trials. 2017;18(1):421.CrossRef
14.
go back to reference Howell AB, Botto H, Combescure C, Blanc-Potard A-B, Gausa L, Matsumoto T, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010;10(1):94.CrossRef Howell AB, Botto H, Combescure C, Blanc-Potard A-B, Gausa L, Matsumoto T, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: a multicentric randomized double blind study. BMC Infect Dis. 2010;10(1):94.CrossRef
15.
go back to reference Butler CC, Francis N, Thomas-Jones E, Longo M, Wootton M, Llor C, et al. Point of care urine culture to inform appropriate antibiotic prescribing for uncomplicated urinary tract infection in primary care (POETIC): a randomised controlled trial of clinical and cost effectiveness. Awaiting Publ. 2017. Butler CC, Francis N, Thomas-Jones E, Longo M, Wootton M, Llor C, et al. Point of care urine culture to inform appropriate antibiotic prescribing for uncomplicated urinary tract infection in primary care (POETIC): a randomised controlled trial of clinical and cost effectiveness. Awaiting Publ. 2017.
16.
go back to reference Watson L, Little P, Moore M, Warner G, Williamson I. Validation study of a diary for use in acute lower respiratory tract infection. Fam Pract. 2001;18(5):553–4.CrossRef Watson L, Little P, Moore M, Warner G, Williamson I. Validation study of a diary for use in acute lower respiratory tract infection. Fam Pract. 2001;18(5):553–4.CrossRef
17.
go back to reference Smith JA, Harré R, Van Langenhove L. Rethinking methods in psychology. Thousand Oaks: Sage; 1995. Smith JA, Harré R, Van Langenhove L. Rethinking methods in psychology. Thousand Oaks: Sage; 1995.
18.
go back to reference Anselm S, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage; 1998. Anselm S, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. Thousand Oaks: Sage; 1998.
19.
go back to reference Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks: Sage; 2006. Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Thousand Oaks: Sage; 2006.
20.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
21.
Metadata
Title
Does cranberry extract reduce antibiotic use for symptoms of acute uncomplicated urinary tract infections (CUTI)? Protocol for a feasibility study
Authors
Oghenekome Gbinigie
Julie Allen
Anne-Marie Boylan
Alastair Hay
Carl Heneghan
Michael Moore
Nicola Williams
Chris Butler
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3860-z

Other articles of this Issue 1/2019

Trials 1/2019 Go to the issue