Precision Management of Urinary Tract Symptoms in Older Women: A Randomized Trial to Reduce Overtreatment
Megan Bradley
Summary
This project aims to improve the diagnosis and management of urinary tract symptoms in older women by comparing three common treatment strategies-empiric antibiotics, urinalysis-guided therapy, and culture-directed care-in a randomized trial. By integrating patient-reported outcomes, laboratory data, the study will identify which patients benefit from antibiotics and which can safely avoid them. Findings will inform precision care strategies and promote antibiotic stewardship while improving symptom outcomes and quality of life in this high-risk population.
Description
Complete a 3-arm randomized pilot trial of either empiric, urinalysis-directed or culture-directed management for UTI symptoms in older women (≥age 65 years old) with a history of recurrent UTI. We will recruit and enroll 90 women with a history of rUTI from the University of Pittsburgh Medical Center - Women's Center for Bladder and Pelvic Health and the Pitt+Me® Research Registry. Once enrolled and randomized, women will be followed for a total of 28 days.
Eligibility
- Age range
- 65+ years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * Female biologic Sex * Age ≥65 years old * History of recurrent UTI per patient report of greater than 2 UTIs in the last 6 months or 3 UTIs in the last year * Patient reported UTI defined as: * Dysuria, increased urinary urgency/frequency and/or suprapubic pain Exclusion Criteria: * Male biologic sex * Age \<65 years old * History of augmentation cystoplasty or cystectomy * Currently performing clean intermittent self-catheterization * Current indwelling foley catheter * Urinary tract instrumentation (i.e., cystourethroscopy, foley catheter placement) in the last 30…
Interventions
- DrugAntibiotics
Participants will be provided either nitrofurantoin 100 mg oral twice a day for 5 days, trimethoprim/sulfamethoxazole 875/125 oral twice a day for 3 days, fosfomycin 3g once oral, ciprofloxacin 250 mg oral twice a day for 5 days or cephalexin 500 mg oral twice a day for 5 days
Location
- UPMC-Magee Womens HospitalPittsburgh, Pennsylvania