Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.

BACKGROUND: Urinary tract infection (UTI) is a common health care problem. Recurrent UTI (RUTI) in healthy non-pregnant women is defined as three or more episodes of UTI during a twelve month period. Long-term antibiotics have been proposed as a prevention strategy for RUTI. OBJECTIVES: To determine the efficacy (during and after) and safety of prophylactic antibiotics used to prevent uncomplicated RUTI in adult non-pregnant women. SEARCH STRATEGY: We searched MEDLINE (1966-April 2004), EMBASE (1980-January 2003), Cochrane Central Register of Controlled Trials( in The Cochrane Library Issue 1, 2004) and reference lists of retrieved articles SELECTION CRITERIA: Any published randomised controlled trial where antibiotics were used as prophylactic therapy in RUTI. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: Nineteen studies involving 1120 women were eligible for inclusion. Antibiotic versus antibiotic (10 trials, 430 women): During active prophylaxis the rate range of microbiological recurrence patient-year (MRPY) was 0 to 0.9 person-year in the antibiotic group against 0.8 to 3.6 with placebo. The RR of having one microbiological recurrence (MR) was 0.21 (95% CI 0.13 to 0.34), favouring antibiotic and the NNT was 1.85. For clinical recurrences (CRPY) the RR was 0.15 (95% CI 0.08 to 0.28). The NNT was 1.85. The RR of having one MR after prophylaxis was 0.82 (95% CI 0.44 to 1.53). The RR for severe side effects was 1.58 (95% CI 0.47 to 5.28) and for other side effects the RR was 1.78 (CI 1.06 to 3.00) favouring placebo. Side effects included vaginal and oral candidiasis and gastrointestinal symptoms. Antibiotic versus antibiotic (eight trials, 513 women): These trials were not pooled. Weekly pefloxacin was more effective than monthly. The RR for MR was 0.31(95% CI 0.19 to 0.52). There was no significant difference in MR between continuous daily and postcoital ciprofloxacin. REVIEWERS' CONCLUSIONS: Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed nodifference between groups. There were more adverse events in the antibiotic group. One RCT compared postcoital versus continuous daily ciprofloxacin and found no significant difference in rates of UTIs, suggesting that postcoital treatment could be offered to woman who have UTI associated with sexual intercourse.

[Rational prescribing and cost reduction in the treatment of arterial hypertension: a simulation exercise]. / Prescripción racional y reducción de costes en el tratamiento de la hipertensión arterial: un ejercicio de simulación.

INTRODUCTION: Cost of antihypertensive drugs in Spain raises 100.000 millions of pesetas. The utilization of new drugs more expensive than classics diuretics and beta blockers is the main reason of this cost increase.The Joint National Commission on Hypertension 6th Report supports the utilization of diuretics and beta blockers as the first choice in patients without any special condition, based in their best efficience. Other professional group don't point out any therapeutic drugs because each of them have their indication. Health authorities have implemented measures intended more to achieve savings than to improve prescriptions. There are not any studies which demonstrate that the second type of measures are more efficient than first one. AIM: To realize an economic evaluation, of a program of blood hypertension treatment taking and not taking into account the The Joint National Commission on Hypertension 6th Report. METHODS: Descriptive, prescription-indication study. Cost minimization. Health center from Valencia (Spain). Three hundred and thirteen patients were studied, randomly selected. Three strategy of cost decrease were considered: a) same prescription profile using the cheapest drugs, b) change of profile taken into account JNC-VI recommendations using the original drugs, and c) second option, but using the cheapest drugs. RESULTS: Ninety seven percent of diuretics had specific indications, 84% of beta blockers, 64.5% of IECAS, 31.6% of alfa blockers and 13% de calcium channel blockers. Diuretics were counter-indicated in 3.5% of patients, beta blockers in 10.5%, and both in 3.1%. Total cost of the unmodifed prescription was 12.412.839 pesetas, cost of the first strategy was 10.067.107, of the second 5.311.783 pesetas and of the third 1.999.094 pesetas. CONCLUSIONS: Our prescription profile don't follow JNC VI recommendations and this is not justified on indications or counterindications of diuretics and beta blockers. Following JNC VI is more efficient than looking only for the cheapest drug.

Prescripción racional y reducción de costes en el tratamientode la hipertensión arterial: un ejercicio de simulación / Rational prescribing and cost reduction in the treatment of arterial hypertension: a simulation exercise

Introducción: El coste de los fármacos antihipertensivos en España supone 100.000 millones de ptas. El gasto ha aumentado por el empleo de medicamentos nuevos más caros que los diuréticos y bloqueadores beta. El sexto Informe del Comité Americano de Hipertensión (JNC-VI) aconseja usar diuréticos y bloqueadores beta como primera opción por su mejor eficiencia. Los gestores sanitarios han planteado medidas ahorradoras antes que racionalizadoras. No hay estudios que comparen la eficiencia de las medidas racionalizadoras y las ahorradoras. Objetivo: Realizar una evaluación económica de un programa de tratamiento de la hipertensión arterial, considerando o no las indicaciones del JNC-VI. Métodos: Estudio descriptivo de prescripción-indicación y minimización de costes en un centro de salud de Valencia. Se estudiaron 313 pacientes seleccionados aleatoriamente. Se valoraron tres estrategias de reducción de costes: a) mismo perfil de prescripción con las especialidades más baratas; b)modificación del perfil según lo aconsejado por el JNC-VI, empleándolos fármacos originales en cada grupo, y c) igual que el anterior pero empleando las especialidades de menor coste. Resultados: Tenían indicaciones específicas el 97% de las prescripciones de diuréticos, el 84% de bloqueadores beta, el 64,5% de inhibidores de la enzima conversiva de la angiotensina, el 31,6% de bloqueadores alfa y el 13% de bloqueadores de los canales del (..) (AU)

Introduction: Cost of antihypertensive drugs in Spain raises100.000 millions of pesetas. The utilization of new drugs more expensives than «classics» diuretics and beta blockers is the main reason of this cost increase. The Joint National Commission on Hypertensiónl 6th Report supports the utilization of diuretics and beta blockers as the first choice in patients without any special condition, based in their best efficience. Other professional group don’t point out any therapeutic drugs because each of them have their indication. Health authorities have implemented measures intended more to achieve «savings» than to improve prescriptions. There are not any study wich demonstrate that the second type of measures are more efficient than first one. Aim: To realize an economic evaluation, of a program of blood hypertension treatment taking and not taking into account the The Joint National Commission on Hypertensiónl 6th Report. Methods: Descriptive, prescription-indication study. Cost minimization. Health center from Valencia (Spain). Three hundred and thirteen patients were studied, randomly selected. Three strategy of cost decrease were considered: a) same prescripction profile using the cheapest drugs, b) change of profile taken into account JNC-VI recommendations using the (..) (AU)

[Program for helping the smoker in primary care. Preliminary evaluation]. / Programa de ayuda al fumador para la atención primaria. Evaluación preliminar.

The program of help to the smoker (PHS) consists of a systematic intervention upon the whole of the demanding population, identifying the smokers and acting on them with a short, concise advise in all visits. The results after 2 months of operation of the PHS in a primary care center are reported. Among 483 persons 104 smokers were detected (23.65%). 27% showed a favorable disposition towards quitting smoking within a short term; only 17% declared to be against quitting. The best response (36.8% of favorable responses) was obtained in the group smoking 20 cigarettes per day or more. The reported data suggest that the PHS could be useful both in heavy and in minimal or moderate smokers. We consider these data as a preliminary evaluation; assessment with data of long term cessation from smoking is required.