Hubs for patients with chronic urinary infections (UTIs) are being set up across Britain to trial long-term antibiotics for treating the debilitating condition.
Hospitals in London, Manchester and Newcastle are now recruiting participants for the landmark clinical trial, which could pave the way for more NHS clinics to offer potentially game-changing treatment.
Rajvinder Khasriya, a consultant urogynaecologist who is the lead investigator of the EAT-UP trial, said they could open other sites at locations including Nottingham, Sheffield and Devon if there is enough interest.
Currently, patients suffering from chronic UTIs – meaning the infection is ongoing and cannot be treated with a short course of antibiotics – must travel to London for support from the nation’s only dedicated NHS clinic.
But if the trial is a success, Khasriya said it could embolden doctors across the country to treat chronic UTI with an extended high dose of antibiotics combined with a urinary antiseptic known as methenamine hippurate (Hiprex).
This treatment regimen was pioneered by the Lower Urinary Tract Symptoms (Luts) Service at the Whittington Hospital, in north London. However, this is one of the only NHS clinics to offer the protocol as it veers away from the standard treatment guidelines set by the National Institute for Health and Care Excellence (Nice).
It comes as the Luts clinic was forced to pause referrals from everyone outside of five London boroughs from 1 March after the waitlist grew to 56 weeks – just over a year. Only patients living in Barnet, Camden, Enfield, Haringey or Islington can continue to be referred to this service.
Khasriya said: “We would like the NHS to help us build specialist clinics for chronic UTI, where we all do the same thing, and all of us have a consensus agreement of how we manage these patients.
“That will be so beneficial for patients. It’s ridiculous that they have to come to London. Across the country, we could set up some UTI clinics just like the mesh services.”
How to sign up to the trial
Where are the locations?
The study is aiming to recruit patients at five locations, including 100 at the Whittington Hospital and around 50 at Guy’s and St Thomas’ in London.
The remaining 50 participants will be spread across University College London Hospital, St Mary’s Hospital in Manchester and Freeman Hospital in Newcastle upon Tyne.
What happens during the trial?
Participants will be randomised and either given the Whittington’s treatment protocol or the Nice standard for a recurrent UTI over three months.
Khasriya said that no patient in the Nice group would be left to suffer if their condition gets worse. They would be given a higher dose of antibiotics to treat their infection.
All patients will be offered full treatment after the three-month trial.
How to get involved?
The trial is for women aged 18+ in the UK who have been living with symptoms for at least three months and who meet the eligibility criteria.
If you are interested, email whh-tr.researchanddevelopment@nhs.net.
No official treatment for chronic UTI
There is currently no official treatment guideline for chronic UTI, so the trial is testing the safety and effectiveness of long-term antibiotics against the Nice “standard of care” for a recurrent UTI. This is a low dose of an antibiotic, known as a prophylactic, or Hiprex.
The trial has set a new definition of chronic UTI as patients with persistent symptoms for more than three months and more than 20 white blood cells in their urine sample.
This is significant as getting this distinct medical definition into a peer-reviewed journal would be likely to trigger more research into this specific cohort of patients. It is hoped that this could eventually prompt Nice to develop a new set of treatment guidelines.
Nice creates guidelines for GPs and hospitals by making “evidence-based recommendations” for NHS England, using “the best available evidence of clinical effectiveness and cost-effectiveness”. The criteria for deciding whether to update guidelines include new clinical areas being identified or the emergence of significant new evidence.
Khasriya also hopes the trial will prove that using “fresh urine microscopy” is a more effective way of diagnosing chronic UTI and developing a tailored treatment plan. This method looks at how a patient responds to bacteria by testing and monitoring their white blood cells and adjusting treatment accordingly.
In contrast, a traditional urine culture tests whether certain bacteria are present in a urine sample, without focusing on how the patient is responding to the bacteria, while the dipstick method used by many GPs can be inaccurate for picking up infections.
Khasriya said each trial site has installed “slide scanners”, which will take a photograph of a urine sample under a microscope. It will be sent to the lab at University College London, where analysts will count how many white blood cells there are in the urine, signifying an infection.
She said this could pave the way for a new “bedside test” diagnosing patients with a chronic UTI, as the results are available within minutes.
In the future, it is hoped that artificial intelligence could be used to analyse the images, meaning it could – in theory – be rolled out at GP surgeries across the country.
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