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Antibiotic therapy for treating overactive bladder is not supported by clinical evidence

Nature Reviews Urology volume 22, pages 366–374 (2025)Cite this article

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Abstract

A number of reports have suggested that the use of prolonged antibiotic treatment could be an effective therapy for patients with overactive bladder (OAB); however, this approach is contrary to existing recommendations regarding the prolonged non-specific use of antibiotics. The existing evidence in this area seems to be circumstantial and anecdotal but, despite this limitation, the use of long-term antibiotic therapy for OAB seems to be increasing. Review and synthesis of the existing evidence for use of antibiotic therapy in patients with OAB identify few studies — just seven papers and four conference proceedings — which are heterogeneous in their design, inclusion and exclusion criteria, treatment regimen employed, approach to the use of antimuscarinic medications, follow-up protocols, and measured outcomes. Overall, the limitation of these published data, the potential adverse events associated with long-term antibiotic use, concerns about antimicrobial resistance and the wide availability of other conventional treatments mean that no compelling data support the routine use of antibiotic therapy and that antibiotic treatment of OAB is not supported by an adequate contemporary evidence base. In the absence of acute urinary tract infection, the management of the non-specific syndrome of OAB should follow existing evidence-based investigational and treatment guidelines. Contemporary therapy following attention to fluid intake relies upon anticholinergic or β3-adrenergic agonist treatment with progression to intravesical onabotulinumtoxinA therapy or neuromodulation in non-responders to oral therapy.

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Fig. 1: The overactive bladder pathogenesis pathways.

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Authors and Affiliations

  1. Sheffield Teaching Hospitals, Sheffield, UK

    Jelizaveta Pereca & Christopher Chapple

  2. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

    Adrian Wagg

  3. University of Alberta, Edmonton, Alberta, Canada

    Megan Kennedy

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  1. Jelizaveta Pereca
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  2. Adrian Wagg
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Contributions

J.P. and M.K. researched data for the article. C.C., J.P. and M.K. contributed substantially to discussion of the content. J.P. wrote the article. C.C., J.P. and A.W. reviewed and/or edited the manuscript before submission.

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Correspondence to Christopher Chapple.

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Pereca, J., Wagg, A., Kennedy, M. et al. Antibiotic therapy for treating overactive bladder is not supported by clinical evidence. Nat Rev Urol 22, 366–374 (2025). https://doi.org/10.1038/s41585-024-00974-9

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