Examination of the Efficacy of Preventive Antibiotic Treatment During the Puerperium Among Pregnant Women With Recurrent Urinary Tract Infections
Urinary tract infection is the most common bacterial infection during pregnancy. Asymptomatic bacteriuria is the most common infection, in up to 8% of the population. Symptomatic infection may cause cystitis or cause pyelonephritis.
Among pregnant women with recurrent bacteriuria, preventive antibiotic treatment has been found to be efficacious in reducing the bacteriuria rate and the complications.
the changes of the urinary tract which appear during pregnancy usually resolve up to 3 months post-partum.
The purpose of this study is to examine the efficacy of preventive antibiotic treatment during the puerperium.
Drug: Preventive antibiotic treatment- NITROFURANTOIN
Drug: Preventive antibiotic treatment- CEPHALEXIN
Drug: PREVENTIVE TREATMENT- AMOXICILLIN
Drug: PREVENTIVE TREATMENT- AMOXICILLIN AND CLAVULANATE POTASSIUM
Drug: PREVENTIVE TREATMENT- CEFUROXIME
Drug: PREVENTIVE TREATMENT SULFAMETHOXAZOLE AND TRIMETHOPRIM
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
|Official Title:||The Efficacy of Preventive Antibiotic Treatment During the Puerperium Among Pregnant Women With Recurrent Urinary Tract Infections|
- Urinary tract complications [ Time Frame: 6 weeks ] [ Designated as safety issue: No ]
|Study Start Date:||January 2012|
|Estimated Study Completion Date:||May 2017|
|Estimated Primary Completion Date:||May 2017 (Final data collection date for primary outcome measure)|
No Intervention: control arm
The women in this arm will stop the preventive antibiotic treatment after the delivery
Active Comparator: preventive antibiotic treatment
The women in this arm will continue the preventive antibiotic treatment after the delivery to 6 weeks
Drug: Preventive antibiotic treatment- NITROFURANTOIN
P.O NITROFURANTOIN 100 mg per day for 6 weeksDrug: Preventive antibiotic treatment- CEPHALEXIN
P.O CEPHALEXIN 500 MG PER DAY FOR 6 WEEKSDrug: PREVENTIVE TREATMENT- AMOXICILLIN
P.O AMOXICILLIN 250 MG PER DAY FOR 6 WEEKSDrug: PREVENTIVE TREATMENT- AMOXICILLIN AND CLAVULANATE POTASSIUM
P.O AMOXICILLIN AND CLAVULANATE POTASSIUM, 875 MG PER DAY FOR 6 WEEKSDrug: PREVENTIVE TREATMENT- CEFUROXIME
P.O CEFUROXIME 250 MG PER DAY FOR 6 WEEKSDrug: PREVENTIVE TREATMENT SULFAMETHOXAZOLE AND TRIMETHOPRIM
P.O SULFAMETHOXAZOLE AND TRIMETHOPRIM 1 TAB PER DAY FOR 6 WEEKS
No Intervention: FOLLOW UP ARM
this arm will include women who do not want to participate in the study, and those women will stop the preventive treatment after delivery, and THE INVESTIGATORS will contact those women to collect information regarding their health status post partum
During pregnancy functional modifications in the urinary tract influence the function of the urinary tract system. Those changes raise the risk of urinary tract infections. The most common bacterial infections during pregnancy are urinary tract infections. Actually, asymptomatic bacteriuria is the most common infection in up to 8% of the population. Symptomatic infection may cause cystitis or include the renal calyces and parenchyma and cause pyelonephritis. There are few common protocols for bacteriuria treatment. The recurrence rate after treatment is 30%. Preventive treatment with nitrofurantoin has been demonstrated to be effective, although there is a small risk to acute respiratory distress which resolved with cessation of the treatment. Renal infection is the most common serious infection during pregnancy. Complication of renal infection can lead to ARDS or urosepsis. Renal infection usually develops during the second trimester and has been related to prim parity and young women.
About 20% of women will deteriorate to renal insufficiency. 30-40% of cases will be followed with recurrent bacteriuria later on, for this reason, a preventive treatment is recommended until delivery. In previous studies the preventive treatment reduced the bacteriuria rate from 38% to 8%.
After delivery, the morphological changes including edema, bladder hyperemia and a raise in the urinary volume, pass away up to 3 months post partum. There is only slight information regarding the rate of bacteriuria during puerperium, most of the information relates to the early puerperium period. In addition, the consequences of such infection are unknown.
The aim of this study is to estimate the efficacy of preventive antibiotic treatment during the puerperium.
- To estimate the rate of bacteriuria and other urinary tract infections during the puerperium among women with preventive treatment during pregnancy
- To evaluate the efficacy of preventive treatment during the puerperium Hypothesis: The pregnancy modifications which cause more urinary tract infections during pregnancy, exist also during the puerperium, and can cause complications Study design Prospective, randomized, open label Study population: Pregnant women with two or more episodes of bacteriuria or one episode of pyelonephritis, whom are treated with prophylactic antibiotic Study period From 6 weeks after delivery The study size has been determined according to a reduction in the bacteriuria rate following preventive treatment from 38% to 8%. Basing on that fact, each group has to include 37 women, to get a 80% power with α=0.05.
Study protocol: women will be randomized at recruitment. Demographic and obstetrical data will be collected. The women in the treatment group will continue the prophylactic treatment after the delivery, for 6 weeks. If the woman breastfeeds, the treatment will be fitted to the situation. Urine culture will be collected the morning following the delivery , 3 and 6 weeks post delivery. The women will be invited to the high risk unit for follow up after 3 and 6 weeks. Details regarding bacteriuria, urinary tract infections, pyelonephritis and admissions for related complications will be collected.
The study was approved by the local Helsinki committee. Time table Duration: one year
Please refer to this study by its ClinicalTrials.gov identifier: NCT01507974
|Dep of OG/GYN, Emek Medical Center||Recruiting|
|Contact: MEIRAV BRAVERMAN, MD 0509384595 firstname.lastname@example.org|
|Principal Investigator: Meirav Braverman, MD|