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

• DOI: 10.1007/s00192-018-3846-5
• Publication Date: 2018-12-18T04:00:42Z
• Authors: Sheela Swamy; Anthony S. Kupelian; Rajvinder Khasriya; Dhanuson Dharmasena; Hristina Toteva; Tara Dehpour; Linda Collins; Jennifer L. Rohn; James Malone-Lee
• Keywords: pharmacy; Adult; Male; Pain; Recurrent UTI; Leukocyte Count; Interstitial cystitis; nursing; Lower Urinary Tract Symptoms; Recurrence; Humans; Pyuria; Aged; Aged, 80 and over; Cross-Over Studies; Chronic UTI; health; Middle Aged; infection; 6. Clean water; UTI guidelines; Anti-Bacterial Agents; 3. Good health; Nitrofurantoin; Withholding Treatment; Chronic Disease; Retreatment; Urinary Tract Infections; Original Article; Female; Bladder pain syndrome; Symptom Assessment; Painful lower urinary tract symptoms

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.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.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.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.