{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:45:22Z","timestamp":1788457522360,"version":"build-2803163510"},"reference-count":20,"publisher":"Royal College of General Practitioners","issue":"699","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Although uncomplicated urinary tract infection (UTI) is commonly treated with antibiotics, the duration of symptoms without their use is not established; this hampers informed decision making about antibiotic use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the natural history of uncomplicated UTI in adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Systematic review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>PubMed was searched for articles published until November 2019, along with reference lists of articles identified in the search. Eligible studies were those involving adults with UTIs in either the placebo group of randomised trials or in single-group prognostic studies that did not use antibiotics and measured symptom duration. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were the percentage of patients who, at any time point, were symptom free, had symptom improvement, or had worsening symptoms (failed to improve). Adverse event data were also extracted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three randomised trials (346 placebo group participants) were identified, all of which specified women only in their inclusion criteria. The risk of bias was generally low, but incomplete reporting of some details limited assessment. Over the first 9 days, the percentage of participants who were symptom free or reported improved symptoms was reported as rising to 42%. At 6 weeks, the percentage of such participants was 36%; up to 39% of participants failed to improve by 6 weeks. The rate of adverse effects was low and, in two trials, progression to pyelonephritis was reported in one placebo participant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although some uncertainty around the natural history of uncomplicated UTIs remains, some women appear to improve or become symptom free spontaneously, and most improvement occurs in the first 9 days. Other women either failed to improve or became worse over a variable timespan, although the rate of serious complications was low.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp20x712781","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T04:25:12Z","timestamp":1600748712000},"page":"e714-e722","source":"Crossref","is-referenced-by-count":37,"title":["Natural history of uncomplicated urinary tract infection without antibiotics: a systematic review"],"prefix":"10.3399","volume":"70","author":[{"given":"Tammy","family":"Hoffmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruwani","family":"Peiris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris Del","family":"Mar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Cleo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Glasziou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"2021021209001406000_70.699.e714.1","doi-asserted-by":"publisher","DOI":"10.3122\/15572625-13-6-392"},{"key":"2021021209001406000_70.699.e714.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2008.12.009"},{"issue":"1","key":"2021021209001406000_70.699.e714.3","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1186\/s12916-018-1109-4","article-title":"Resistance decay in individuals after antibiotic exposure in primary care: a systematic review and meta-analysis","volume":"16","author":"Bakhit","year":"2018","journal-title":"BMC Med"},{"issue":"3","key":"2021021209001406000_70.699.e714.4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1001\/jamainternmed.2016.8254","article-title":"Clinicians\u2019 expectations of the benefits and harms of treatments, screening, and tests: a systematic review","volume":"177","author":"Hoffmann","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2021021209001406000_70.699.e714.5","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2040"},{"key":"2021021209001406000_70.699.e714.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7306.224"},{"issue":"123","key":"2021021209001406000_70.699.e714.7","first-page":"695","article-title":"Sulphadimidine, co-trimoxazole, and a placebo in the management of symptomatic urinary tract infection in general practice","volume":"22","author":"Brooks","year":"1972","journal-title":"J R Coll Gen Pract"},{"issue":"482","key":"2021021209001406000_70.699.e714.8","first-page":"729","article-title":"Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women","volume":"52","author":"Christiaens","year":"2002","journal-title":"Br J Gen Pract"},{"key":"2021021209001406000_70.699.e714.9","doi-asserted-by":"publisher","DOI":"10.1080\/00365540410019642"},{"key":"2021021209001406000_70.699.e714.10","doi-asserted-by":"publisher","DOI":"10.1080\/02813430601183074"},{"key":"2021021209001406000_70.699.e714.11","unstructured":"Continence Foundation of Australia Your guide to UTIs CFA https:\/\/continence.org.au\/news\/your-guide-utis (accessed 6 September 2020)."},{"issue":"4","key":"2021021209001406000_70.699.e714.12","first-page":"CD010745","article-title":"Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women","volume":"4","author":"O\u2019Kane","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"issue":"Suppl 4","key":"2021021209001406000_70.699.e714.13","doi-asserted-by":"crossref","first-page":"10","DOI":"10.2165\/00003495-199100424-00005","article-title":"Single dose oral administration of cefixime 400mg in the treatment of acute uncomplicated cystitis and gonorrhoea","volume":"42","author":"Asbach","year":"1991","journal-title":"Drugs"},{"issue":"3","key":"2021021209001406000_70.699.e714.14","first-page":"90","article-title":"[Treatment of urinary infection with a single dose of co-trimoxazole compared with a single dose of amoxicillin and a placebo]","volume":"112","author":"Dubi","year":"1982","journal-title":"Schweiz Med Wochenschr"},{"key":"2021021209001406000_70.699.e714.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b5633"},{"key":"2021021209001406000_70.699.e714.16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq257"},{"key":"2021021209001406000_70.699.e714.17","unstructured":"National Institute for Health and Care Excellence Urinary tract infection (lower): antimicrobial prescribing London NICE 2018 https:\/\/www.nice.org.uk\/guidance\/ng109 (accessed 17 Apr 2020)."},{"key":"2021021209001406000_70.699.e714.18","unstructured":"Therapeutic Guidelines Limited Treatment of acute cystitis in adults Melbourne Therapeutic Guidelines Limited (eTG December 2019 edition)."},{"key":"2021021209001406000_70.699.e714.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4784"},{"key":"2021021209001406000_70.699.e714.20","doi-asserted-by":"crossref","unstructured":"Scott AM Clark J Del Mar C Glasziou P Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis Br J Gen Pract 2020 DOI:https:\/\/doi.org\/10.3399\/bjgp20X708125","DOI":"10.3399\/bjgp20X708125"}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/bjgp20X712781","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:56:27Z","timestamp":1645818987000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjgp.org\/lookup\/doi\/10.3399\/bjgp20X712781"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,21]]},"references-count":20,"journal-issue":{"issue":"699","published-online":{"date-parts":[[2020,10,1]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.3399\/bjgp20X712781"],"URL":"https:\/\/doi.org\/10.3399\/bjgp20x712781","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,21]]}}}