To Treat or Not to Treat? That Is the Question

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Having bacteria in the urine without exhibiting symptoms is common among women with diabetes, say researchers investigating the issue of whether to treat this condition with antibiotics.

Treating women with diabetes who have non-symptom-producing bacteria in their urine has no better outcome than failing to treat the bacteria, according to a study from Manitoba, Canada, that compared the incidence of urinary tract infections both with and without prior treatment of bacteria in the urine.

The researchers studied 105 women with diabetes who had bacteria in their urine. Fifty were randomly selected to receive a placebo, while 55 received anti-microbial therapy. The study was double-blinded for the first six weeks, after which the women were screened every three months for up to three years. Those in the initial anti-microbial therapy group who were later found to have bacteria in their urine were treated.

Among the women who took a placebo, 78 percent had bacteria in their urine four weeks after the initial therapy, compared to only 20 percent of those who had received the anti-microbial agent. During a follow-up that occurred, on average, 27 months later, 40 percent of the women in the placebo group had at least one episode of a symptomatic urinary tract infection. And so did 42 percent of the women who received the anti-microbial therapy.

Because treating asymptomatic bacteria in the urine doesn’t appear to reduce the chance of getting symptomatic urinary tract infections, diabetes by itself should not be an indication to treat the bacterial condition, the researchers argue.

—New England Journal of Medicine, November 14, 2002

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