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Antibiotic Therapy for Treating Overactive Bladder Is Not Supported by Clinical Evidence - Beyond the Abstract

This study used the state-of-the-art Joanna Briggs Institute scoping review method and reporting framework to comprehensively gather relevant data, regardless of type to address its research question, what is the evidence for the role of antibiotics in the management of OAB? This method is a comprehensive, systematic approach to data gathering and synthesis which allows an assessment of the state of the evidence and identifies research direction. With the aid of a librarian scientist, a search of Medline, Ovid Embase, CINAHL, Scopus, Web of Science, CENTRAL, and Cochrane Library online databases using combinations of medical subject headings and keywords based on: “overactive bladder” and “antibiotics" for the abstracts published in English between May 1998 and May 2023 was conducted. After the removal of duplicates, 353 papers were systematically reviewed for eligibility resulting in eleven inclusions for the paper.

Sub-clinical cystitis has long been associated with overactive bladder symptoms and the existence of sub-urothelial bacterial colonies has been demonstrated in humans and animals. Although some supportive animal data might establish a rationale for the use of longer-term antibiotics in the treatment of overactive bladder, and reports of some differences in the bacterial urinary microbiome in patients with OAB compared to control subjects without OAB, there remains a paucity of human data which might assess the effect of a longer-term treatment regimen. Following evidence retrieval and synthesis, it remains clear that there are no compelling data that might support the clinical use of long-term antibiotics in this scenario. Trials assessing antibiotics were non-comparable in terms of regimen employed, eligible patients, and the outcome assessment. Only three studies addressed adverse events related to antibiotic use and antibiotic resistance. There appears to be still much to investigate in this contentious area.

Written by: Adrian Wagg, MB, BS, FRCP(LOND), FRCP(EDIN), FCGS FHEA(MD), Professor of Healthy Aging, College of Health Sciences, Faculty of Medicine & Dentistry, Department of Medicine, Division of Geriatric Medicine, Edmonton, AB Canada

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