Antibiotics for urinary tract infections: efficacy, long-term safety and antimicrobial resistance

Methenamine: used by women for a century to treat urinary tract infections, with poor quality evidence both for efficacy and long-term side effects

PhD candidate: Ingrid Hoff

Supervisors:
Edoardo Botteri (the Norwegian Cancer Register/Norwegian Institute for Public Health), Bjørn Blomberg (University of Bergen/Haukeland university hospital). Siri Vangen (Norwegian Research Centre for Women`s Health). Hege Kersten (University of Oslo/Telemark hospital trust).

Background
Urinary tract infection (UTI) is one of the most common infectious diseases affecting women with premenopausal women being 20-40 times more likely to have a UTI than men of the same age. At the same time, Norwegian women has the world`s highest incidence of colorectal cancer (CRC), for reasons uknown. Given the high consumption of antibiotics, including prophylactic agents against UTIs – we want to investigate if there is a potential connection between use of antibiotics for UTIs and later development of cancer.

Beside the risk of cancer possibly associated with the use of antibiotics, it is important to lay emphasis on the global antimicrobial resistance (AMR) crisis. The United Nations estimate 10 million deaths annually attributable to AMR by the year of 2050. Norway has among the world’s lowest rates of AMR. Optimizing antibiotic prescriptions for UTIs could potentially contribute to reducing AMR globally.

About the project
The principal investigator will be Edoardo Botteri, the co-supervisors will be professor Bjørn Blomberg, professor emeritus Siri Vangen, and professor Hege Kersten. The project will be based on a close collaboration between the CRN (NIPH), which has long experience in register-based research and have established the BCSN-database which is pivotal in this project, and Oslo University Hospital (Norwegian Research Centre for Women`s Health), Haukeland University Hospital, Telemark Hospital and University of Bergen.

Goal
The main aim of this study is to evaluate if there is an association between use of antibiotics - and the risk of colorectal cancer. Additionally, the project aims to assess the effectiveness of drugs for the prevention of UTI, especially with regards to reduction of emerging AMR in urinary pathogens. This risk-benefit profile will be evaluated for all antibiotics, because any strategies aiming to reduce UTI re-occurrence, cancer risk and AMR will be of great benefit to society.

Cooperation
The project is funded by the Norwegian Research Centre for Women`s Health, Oslo University Hospital. In close collaboration with the Norwegian Cancer Register (part of the Norwegian institute for Public health), as well as Haukeland university hospital and Sykehuset Telemark.