***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: We conducted a r and omized , double-blind , placebo-controlled study to determine the efficacy of postcoital antibiotic prophylaxis in healthy young women prone to recurrent urinary tract infections . Sixteen patients were r and omized to receive postcoital administration of a combination product of trimethoprim and sulfamethoxazole , while 11 received postcoital placebo .  The treatment groups were similar with respect to age , parity , diaphragm use , history of lifetime urinary tract infections , frequency of intercourse , and number of lifetime sexual partners . In over 6 months of observation , postcoital administration of trimethoprim-sulfamethoxazole was highly effective in preventing recurrent urinary tract infections . Nine of 11 patients who took the placebo developed urinary tract infections ( infection rate , 3.6 per patient-year ) , compared with only two of 16 patients who received postcoital trimethoprim-sulfamethoxazole ( infection rate , 0.3 per patient-year ) . Postcoital administration of trimethoprim-sulfamethoxazole was effective in patients with both low ( two or fewer times per week ) and high ( three or more times per week ) intercourse frequencies . Side effects were few and compliance was excellent . We conclude that postcoital trimethoprim-sulfamethoxazole is a safe , effective , and inexpensive approach to management of recurrent urinary tract infections in young women PURPOSE We evaluated and compared the efficacy of post-intercourse and daily oral ciprofloxacin prophylaxis against  recurrent lower urinary tract infections in 135 sexually active premenopausal women . MATERIAL S AND METHODS Post-intercourse ( group 1 , 70 patients ) and daily ( group 2 , 65 patients )  prophylactic regimens of 125 mg . ciprofloxacin were started following a curative , conventional treatment of the initial acute urinary tract infection . Prophylaxis was maintained for 12 months and during this period patients were followed clinical ly and bacteriologically with urine and introital sample s. Patients were subsequently followed for an additional year after the end of preventive treatment . RESULTS While 3.67 urinary tract infections per patient in group 1 and 3.74 in group 2 occurred during an identical mean time of 12.2 months before start of the corresponding prophylactic regimen , only 0.043 infection per patient in group 1 and 0.031 in group 2 developed during prophylaxis ( p < 0.0001 ) . Before prophylaxis 86 % of the vaginal vestibule cultures yielded gram-negative Enterobacteriaceae , equally distributed between both treatment arms , compared to 5.6 % and 2.5 % during postcoital and daily prophylaxis , respectively . The overall improvement in the incidence of the urinary infections per patient and the rate of introital colonization with enteric gram-negative bacteria was maintained after the end of prophylaxis , with a mean incidence of infections of 0.44 per patient ( occurring in 34 % of the total patient population ) , while 36 % of all women had abnormal introital colonization . CONCLUSIONS Long-term post-intercourse prophylaxis with ciprofloxacin proved to be equally effective as daily prophylaxis , and the major advantage of the former therapy was use of only a third of the amount of drug consumed in daily prophylaxis The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Purpose To test whether d-mannose powder is effective for recurrent urinary tract infection ( UTI ) prevention . Material s and methods After initial antibiotic treatment of acute cystitis , 308 women with history of recurrent UTI and no other significant comorbidities were r and omly allocated to three groups . The first group ( n = 103 ) received prophylaxis with 2 g of d-mannose powder in 200 ml of water daily for 6 months , the second ( n = 103 ) received 50 mg Nitrofurantoin daily , and the third ( n = 102 ) did not receive prophylaxis . Results Overall 98 patients ( 31.8 % ) had recurrent UTI : 15 ( 14.6 ) in the d-mannose group , 21 ( 20.4 ) in Nitrofurantoin group , and 62 ( 60.8 ) in no prophylaxis group , with the rate significantly higher in no prophylaxis group compared to active groups ( P < 0.001 ) . Patients in d-mannose group and Nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group ( RR 0.239 and 0.335 , P < 0.0001 ) . In active groups , 17.9 % of patients reported side effects but they were mild and did not require stopping the prophylaxis . Patients in d-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group ( RR 0.276 , P < 0.0001 ) , but the clinical importance of this finding is low because Nitrofurantoin was well tolerated . Conclusions In our study , d-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group . More studies will be needed to vali date the results of this study , but initial findings show that d-mannose may be useful for UTI prevention To study once-daily antimicrobial prophylaxis of urinary tract infections , we gave trimethoprim-sulfamethoxazole ( 40 mg/200 mg ) , trimethoprim ( 100 mg ) , nitrofurantoin macrocrystals ( 100 mg ) , or placebo to 60 women for 6 months . During prophylaxis , infections per patient year were comparable in the groups receiving trimethoprim ( 0.0 ) , nitrofurantoin ( 0.14 ) , or trimethoprim-sulfamethoxazole ( 0.15 ) and occurred less frequently than in patients receiving placebo ( 2.8 ; P less than 0.001 , placebo versus each drug regimen ) . The effectiveness of prophylaxis was limited to the 6 months that antimicrobials were given , and infections were more likely to develop after prophylaxis in women who had three or more infections in the year before prophylaxis ( P less than 0.005 ) . Further , women whose preprophylaxis infection was positive for antibody-coated bacteria were more likely to have same-strain relapse when infections recurred ( P = 0.001 ) . Emergence of trimethoprim-resistant Escherichia coli was rare , but non-E. coli infections occurred more often after prophylaxis ( P less than 0.05 ) . Prophylaxis with these drugs is effective , well tolerated , and did not produce emergence of resistant E. coli but may predispose to non-E. coli urinary tract infections after its discontinuation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal ( NM ) therapy for preventing urinary tract infection ( UTI ) in postmenopausal women with recurrent UTI . Over a period of 9 months , 86 women received an  estriol-containing vaginal pessary ( 0.5 mg estriol ) twice weekly , and 85 women received NM ( 100 mg ) once daily . We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM ( P=.0003 ) . Twenty-eight women ( 32.6 % ) who received estriol had no episodes of UTI versus 41 women ( 48.2 % ) in the NM group . There was a significant increase in the number of superficial cells in women who received estriol , whereas in the NM group , no such changes occurred . However , there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol . Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women OBJECTIVE to provide an up date of the definition , epidemiology , clinical presentation , investigation , treatment , and prevention of  recurrent urinary tract infections in women . OPTIONS continuous antibiotic prophylaxis , post-coital antibiotic prophylaxis , and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection . Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives . EVIDENCE a search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature . Results were restricted to systematic review s , r and omized control trials/controlled clinical trials , and observational studies . There were no date restrictions . VALUES this up date is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada . Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care ( Table 1 ) . OPTIONS recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented . Different prophylaxis options can be selected according to each patient 's characteristics Background The Emergency Department ( ED ) is a frequent site of antibiotic use ; poor adherence with evidence -based guidelines and broad-spectrum antibiotic overuse is common . Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections ( UTI ) compared to the 2010 International Clinical Practice Guidelines ( ICPG ) . Methods A single center , prospect i ve , observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs . Clinician-directed antibiotic treatment was compared to the ICPG using a st and ardized case definition for non-adherence . Binomial confidence intervals and student ’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis . Regression models were used to analyze the significance of various predictors to non-adherent treatment . Results 103 cases met the inclusion and exclusion criteria , with 63.1 % receiving non-adherent treatment , most commonly use of a fluoroquinolone ( FQ ) in cases with cystitis ( 97.6 % ) . In cases with pyelonephritis , inappropriate antibiotic choice ( 39.1 % ) and no initial IV antibiotic for pyelonephritis ( 39.1 % ) where recommended were the most common characterizations of non-adherence . Overall , cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis ( OR 0.9 , 95 % confidence interval 0.4–2.2 , P = 0.90 ) . In multivariable analysis , patients more likely to receive non-adherent treatment included those without a recent history of a UTI ( OR 3.8 , 95 % CI 1.3–11.4 , P = 0.02 ) and cystitis cases with back or abdominal pain only ( OR 11.4 , 95 % CI 2.1–63.0 , P = 0.01 ) . Conclusions Patients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment , potentially suggesting diagnostic inaccuracy . Physician education on evidence -based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens In a r and omised , double-blind trial two single-dose regimens of ciprofloxacin were evaluated for treatment of acute urinary tract infection ( UTI ) in women . Fifty-three women received 250 mg and 46 750 mg of ciprofloxacin . Seven days after treatment the eradication rate was 81.1 % and 82.6 % in the low and high dose groups respectively ; the clinical cure rate at 28 days was 64.1 % and 73.9 % respectively . In women with recurrent UTI a significantly better response was found with the high dose regimen ( 92 % versus 68 % ; p<0.00 
    Output:
    
Our treatment algorithm is based on the best available evidence , and fills a gap in the literature and practice regarding effective strategies to prevent recurrent urinary tract infection in women