{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:17:19Z","timestamp":1780064239175,"version":"3.54.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T00:00:00Z","timestamp":1535414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012068","name":"Health and Care Research Wales","doi-asserted-by":"publisher","award":["DRF-2014-07-010"],"award-info":[{"award-number":["DRF-2014-07-010"]}],"id":[{"id":"10.13039\/100012068","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Farr Institute CIPHER"},{"DOI":"10.13039\/501100000341","name":"Arthritis Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000341","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009250","name":"National Institute for Social Care and Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009250","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000589","name":"Chief Scientist Office","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000589","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["MR\/K006525\/1"],"award-info":[{"award-number":["MR\/K006525\/1"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>this was a retrospective cohort study of health records from 19,696 adults aged \u226565 with recurrent UTIs. We used prescription records to ascertain \u22653 months\u2019 prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>of 4,043 men and 15,653 women aged \u226565 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45\u20130.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51\u20130.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64\u20130.94). In women, prophylaxis was also associated with a reduced risk of clinical recurrence (HR, 0.57; 95% CI, 0.55\u20130.59) and acute antibiotic prescribing (HR, 0.61; 95% CI, 0.59\u20130.62), but estimates of the risk of UTI-related hospitalisation were inconsistent between our main analysis (HR, 1.16; 95% CI, 1.05\u20131.28) and sensitivity analysis (HR, 0.82; 95% CI, 0.72\u20130.94).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>antibiotic prophylaxis was associated with lower rates of UTI recurrence and acute antibiotic prescribing in older adults. To fully understand the benefits and harms of prophylaxis, further research should determine the frequency of antibiotic-related adverse events and the impact on antimicrobial resistance and quality of life.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afy146","type":"journal-article","created":{"date-parts":[[2018,8,13]],"date-time":"2018-08-13T07:09:48Z","timestamp":1534144188000},"page":"228-234","source":"Crossref","is-referenced-by-count":19,"title":["Antibiotic prophylaxis and clinical outcomes among older adults with recurrent urinary tract infection: cohort study"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0634-8548","authenticated-orcid":false,"given":"Haroon","family":"Ahmed","sequence":"first","affiliation":[{"name":"Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Farewell","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hywel M","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick A","family":"Francis","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shantini","family":"Paranjothy","sequence":"additional","affiliation":[{"name":"Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C","family":"Butler","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,8,28]]},"reference":[{"key":"2019121022391424700_afy146C1","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"GBD 2015 Disease and Injury Incidence and Prevalence Collaborators","year":"2016","journal-title":"Lancet"},{"key":"2019121022391424700_afy146C2","doi-asserted-by":"crossref","first-page":"e002007","DOI":"10.1136\/bmjopen-2012-002007","article-title":"Is secondary preventive care improving? Observational study of 10-year trends in emergency admissions for conditions amenable to ambulatory care","volume":"3","author":"Bardsley","year":"2013","journal-title":"BMJ Open"},{"key":"2019121022391424700_afy146C3","author":"Wittenberg"},{"key":"2019121022391424700_afy146C4","doi-asserted-by":"crossref","first-page":"819","DOI":"10.2165\/11595050-000000000-00000","article-title":"Antimicrobial prescribing in nursing homes in Northern Ireland: results of two point-prevalence surveys","volume":"28","author":"McClean","year":"2011","journal-title":"Drugs Aging"},{"key":"2019121022391424700_afy146C5","doi-asserted-by":"crossref","first-page":"1781","DOI":"10.1093\/jac\/dks085","article-title":"Antimicrobial prescribing in residential homes","volume":"67","author":"McClean","year":"2012","journal-title":"J Antimicrob Chemother"},{"key":"2019121022391424700_afy146C6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta18630","article-title":"Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes","volume":"18","author":"Hood","year":"2014","journal-title":"Health Technol Assess"},{"key":"2019121022391424700_afy146C7","doi-asserted-by":"crossref","first-page":"316","DOI":"10.5489\/cuaj.687","article-title":"Guidelines for the diagnosis and management of recurrent urinary tract infection in women","volume":"5","author":"Dason","year":"2011","journal-title":"Can Urol Assoc J"},{"key":"2019121022391424700_afy146C8","author":"Urology EAo"},{"key":"2019121022391424700_afy146C9","doi-asserted-by":"crossref","first-page":"e015233","DOI":"10.1136\/bmjopen-2016-015233","article-title":"Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials","volume":"7","author":"Ahmed","year":"2017","journal-title":"BMJ Open"},{"key":"2019121022391424700_afy146C10","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1016\/j.vaccine.2009.10.081","article-title":"Difficulties in recruiting older people in clinical trials: an examination of barriers and solutions","volume":"28","author":"Ridda","year":"2010","journal-title":"Vaccine"},{"key":"2019121022391424700_afy146C11","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ije\/dyv098","article-title":"Data Resource Profile: Clinical Practice Research Datalink (CPRD)","volume":"44","author":"Herrett","year":"2015","journal-title":"Int J Epidemiol"},{"key":"2019121022391424700_afy146C12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/1471-2288-11-101","article-title":"Additive and multiplicative hazards modeling for recurrent event data analysis","volume":"11","author":"Lim","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"2019121022391424700_afy146C13","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/fampra\/cml012","article-title":"Methods for analysing recurrent events in health care data. Examples from admissions in Ebeltoft Health Promotion Project","volume":"23","author":"Thomsen","year":"2006","journal-title":"Fam Pract"},{"key":"2019121022391424700_afy146C14","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1093\/ije\/dyu222","article-title":"Modelling recurrent events: a tutorial for analysis in epidemiology","volume":"44","author":"Amorim","year":"2015","journal-title":"Int J Epidemiol"},{"key":"2019121022391424700_afy146C15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2296-11-1","article-title":"Adaptation and validation of the Charlson Index for Read\/OXMIS coded databases","volume":"11","author":"Khan","year":"2010","journal-title":"BMC Fam Pract"},{"key":"2019121022391424700_afy146C16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1001\/2013.jamainternmed.829","article-title":"Urinary tract infection in male veterans: treatment patterns and outcomes","volume":"173","author":"Drekonja","year":"2013","journal-title":"JAMA Intern Med"},{"key":"2019121022391424700_afy146C17","first-page":"Cd001209","article-title":"Antibiotics for preventing recurrent urinary tract infection in non-pregnant women","volume":"3","author":"Albert","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"2019121022391424700_afy146C18","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1001\/archinternmed.2012.777","article-title":"Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women","volume":"172","author":"Beerepoot","year":"2012","journal-title":"Arch Intern Med"},{"key":"2019121022391424700_afy146C19","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1093\/jac\/dkn489","article-title":"Cranberry or trimethoprim for the prevention of recurrent urinary tract infections? A randomized controlled trial in older women","volume":"63","author":"McMurdo","year":"2009","journal-title":"J Antimicrob Chemother"},{"key":"2019121022391424700_afy146C20","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1086\/374341","article-title":"Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women","volume":"36","author":"Raz","year":"2003","journal-title":"Clin Infect Dis"},{"key":"2019121022391424700_afy146C21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s00345-013-1091-6","article-title":"D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial","volume":"32","author":"Kranjcec","year":"2014","journal-title":"World J Urol"},{"key":"2019121022391424700_afy146C22","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1111\/dme.12384","article-title":"New estimates of the burden of acute community-acquired infections among older people with diabetes mellitus: a retrospective cohort study using linked electronic health records","volume":"31","author":"McDonald","year":"2014","journal-title":"Diabet Med"},{"key":"2019121022391424700_afy146C23","doi-asserted-by":"crossref","first-page":"e75131","DOI":"10.1371\/journal.pone.0075131","article-title":"Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study","volume":"8","author":"Millett","year":"2013","journal-title":"PLoS One"},{"key":"2019121022391424700_afy146C24","first-page":"5","article-title":"Sources, uses, strengths and limitations of data collected in primary care in England","volume":"21","author":"Majeed","year":"2004","journal-title":"Health Stat Q"},{"key":"2019121022391424700_afy146C25","doi-asserted-by":"crossref","first-page":"e128","DOI":"10.3399\/bjgp10X483562","article-title":"Validity of diagnostic coding within the General Practice Research Database: a systematic review","volume":"60","author":"Khan","year":"2010","journal-title":"Br J Gen Pract"},{"key":"2019121022391424700_afy146C26","author":"Urinary tract infections in adults"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ageing\/article-pdf\/48\/2\/228\/28251067\/afy146.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ageing\/article-pdf\/48\/2\/228\/28251067\/afy146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,12,10]],"date-time":"2019-12-10T22:43:33Z","timestamp":1576017813000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/48\/2\/228\/5085056"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,28]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2018,8,28]]},"published-print":{"date-parts":[[2019,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afy146","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,3]]},"published":{"date-parts":[[2018,8,28]]}}}