さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections A Randomized Clinical Trial

JAMA Intern Med に報告された、水分摂取と再発UTIについてのRCT

 

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705079

 

感想

抗菌薬を使用せずに、再発エピソードを優位に低下させたことは素晴らしい!

しかし、毎日1.5L水を飲めって、、厳しめ。

 

Abstract

Importance  Increased hydration is often recommended as a preventive measure for women with recurrent cystitis, but supportive data are sparse.

Objective  To assess the efficacy of increased daily water intake on the frequency of recurrent cystitis in premenopausal women.

Design, Setting, and Participants  Randomized, open-label, controlled, 12-month trial at a clinical research center (years 2013-2016). Among 163 healthy women with recurrent cystitis (≥3 episodes in past year) drinking less than 1.5 L of fluid daily assessed for eligibility, 23 were excluded and 140 assigned to water or control group. Assessments of daily fluid intake, urinary hydration, and cystitis symptoms were performed at baseline, 6- and 12-month visits, and monthly telephone calls.

Interventions  Participants were randomly assigned to drink, in addition to their usual fluid intake, 1.5 L of water daily (water group) or no additional fluids (control group) for 12 months.

Main Outcomes and Measures  Primary outcome measure was frequency of recurrent cystitis over 12 months. Secondary outcomes were number of antimicrobial regimens used, mean time interval between cystitis episodes, and 24-hour urinary hydration measurements.

Results  The mean (SD) age of the 140 participants was 35.7 (8.4) years, and the mean (SD) number of cystitis episodes in the previous year was 3.3 (0.6). During the 12-month study period, the mean (SD) number of cystitis episodes was 1.7 (95% CI, 1.5-1.8) in the water group compared with 3.2 (95% CI, 3.0-3.4) in the control group, with a difference in means of 1.5 (95% CI, 1.2-1.8; P < .001). Overall, there were 327 cystitis episodes, 111 in the water group and 216 in the control group. The mean number of antimicrobial regimens used to treat cystitis episodes was 1.9 (95% CI, 1.7-2.2) and 3.6 (95% CI, 3.3-4.0), respectively, with a difference in means of 1.7 (95% CI, 1.3-2.1; P < .001). The mean time interval between cystitis episodes was 142.8 (95% CI, 127.4-160.1) and 84.4 (95% CI, 75.4-94.5) days, respectively, with a difference in means of 58.4 (95% CI, 39.4-77.4; P < .001). Between baseline and 12 months, participants in the water group, compared with those in the control group, had increased mean (SD) urine volume (1.4 [0.04] vs 0.1 [0.04] L; P < .001) and voids (2.4 [0.2] vs −0.1 [0.2]; P < .001) and decreased urine osmolality (−402.8 [19.6] vs −24.0 [19.5] mOsm/kg; P < .001).

Conclusions and Relevance  Increased water intake is an effective antimicrobial-sparing strategy to prevent recurrent cystitis in premenopausal women at high risk for recurrence who drink low volumes of fluid daily.

Trial Registration  ClinicalTrials.gov identifier: NCT02444975

 

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