A Critical Review of Recent Randomized Controlled Clinical Trials in the Treatment of Asymptomatic Bacteriuria of Pregnancy |
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| Affiliation: | 1. Department of Urology, Louisiana State University Health Sciences Center, Shreveport, Estados Unidos;2. Louisiana State University Health Sciences Center, School of Medicine Shreveport, LA, Estados Unidos;3. Department of Surgery, King Hussein Cancer Center, Ammán, Jordania;4. Department of Urology, Mayo Clinic, Rochester, Estados Unidos;1. Second Department of Urology, National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece;2. Department of Urology, Hospital of the Sisters of Charity, Urologische Praxis mit Steinzentrum, Vienna, Austria;1. Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands;2. Department of Urology, University of Leuven, Leuven, Belgium;3. Department of Urology, Medical University of Innsbruck, Innsbruck, Austria;4. Division of Pediatric Urology, Hacettepe University, Ankara, Turkey;5. Department of Urology and Pediatric Urology, University Medical Center Groningen, Rijks University Groningen, Groningen, the Netherlands;6. Department of Urology, Aarhus, Denmark;7. Division of Pediatric Urology, Department of Urology, Istanbul Biruni University, Istanbul, Turkey;8. Department of Urology, East of England Deanery, Urology, Cambridge, United Kingdom;9. Center for Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University of Medical Center Mannheim, Heidelberg University, Mannheim, Germany;1. University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA;2. Case Western Reserve University School of Medicine, Cleveland, OH, USA;3. Department of Urology and Transplantation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA |
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| Abstract: | The randomized clinical trial represents the gold standard of intervention studies in clinical medicine. This is partly due to the validity of results obtained when confounders, both known and unknown, are assigned equally to treatment groups without the practitioners’ bias of treatment selection. Few clinical trials exist to assess the effectiveness of various treatment regimes for asymptomatic bacteriuria of pregnancy. This study reviews critically the randomized controlled clinical trials for the treatment of asymptomatic bacteriuria of pregnancy. Articles for the review were obtained through a literature search employing MEDLINE over a ten-year period. Nine randomized trials resulted from the search that were in the English language or had English translation available. These included five randomized trials without control groups done in a single centre, and one trial with a control group assessing prophylaxis against recurrent asymptomatic bacteriuria.Review of these studies finds that single dose therapy when compared to longer dosing regimes shows a trend to a higher cure rate but that all of the studies were under-powered. This lack of power results in a significant beta error. No difference between short and long term therapy could, therefore, be shown statistically. When a control group is introduced into the randomized trial, a high rate of spontaneous resolution is seen. Short term therapy resulted in a lower cure rate when compared to no treatment in this setting and only three day or greater treatments showed cure rates above spontaneous remission rates. The only study addressing prophylaxis was severely under-powered and suffered technical complications leading to the inability to draw any conclusions. Adequately powered studies to show effectiveness of single dose therapy and prophylaxis of asymptomatic bacteriuria of pregnancy are needed. |
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| Keywords: | Pregnancy bacteriuria |
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