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Meta-Analysis
. 2007 Oct 17;2007(4):CD003237.
doi: 10.1002/14651858.CD003237.pub2.

Modes of administration of antibiotics for symptomatic severe urinary tract infections

A Pohl  1
Affiliations
Meta-Analysis

Modes of administration of antibiotics for symptomatic severe urinary tract infections

A Pohl. Cochrane Database Syst Rev. .

Abstract

Background: Urinary tract infection (UTI), worldwide, is a major source of disease in children and adults. As it may have long-term consequences such as kidney failure and hypertension, it is important to treat patients with UTI adequately. Although standard management of severe UTI usually means intravenous (IV) therapy, at least initially, there are studies showing that oral therapy may also be effective.

Objectives: To assess whether the mode of administration of antibiotic therapy for severe UTI has an effect on cure rate, reinfection rate and kidney scarring.

Search strategy: The Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE and EMBASE were searched. No language restriction was applied. Reference lists of relevant articles and reviews were checked for additional studies and authors of relevant articles/abstracts were contacted for further information. Date of last search: July 2007.

Selection criteria: All randomised controlled trials (RCTs) comparing different modes of antibiotic application for patients with severe UTI (children and adults) were considered.

Data collection and analysis: Study quality was assessed and data extracted. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or mean difference (WMD) for continuous data with 95% confidence intervals (CI).

Main results: Fifteen RCTs (1743 patients) were included. Studies compared oral versus parenteral treatment (1), oral versus switch treatment (initial intravenous (IV) or intramuscular (IM) therapy followed by oral therapy) (5), switch versus parenteral treatment (6) and single dose parenteral followed by oral therapy versus oral (1) or switch therapy (3). There was a variety of short-term and long-term outcomes, but no pooled outcomes showed significant differences. Most included studies were small though and there were few outcomes for combination in a meta-analysis.

Authors' conclusions: There is no evidence suggesting that oral antibiotic therapy is less effective for treatment of severe UTI than parenteral or initial parenteral therapy. The results of this review suggest that the mode of application does not determine therapeutic success.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 1 Fever after 48 hours.
1.2
1.2. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 2 Bacteriological cure under therapy.
1.3
1.3. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 3 Clinical cure at end of treatment.
1.4
1.4. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 4 Bacteriological cure at end of treatment.
1.5
1.5. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 5 Clinical and bacteriological cure at end of treatment.
1.6
1.6. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 6 Reinfection at end of treatment.
1.7
1.7. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 7 Clinical and bacteriological cure after interval.
1.8
1.8. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 8 Relapse after interval.
1.9
1.9. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 9 Reinfection after interval.
1.10
1.10. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 10 Renal scarring (DMSA scan) after 6 months.
1.11
1.11. Analysis
Comparison 1 Switch versus parenteral therapy, Outcome 11 Adverse events.
2.1
2.1. Analysis
Comparison 2 Oral versus switch therapy, Outcome 1 Clinical and bacteriological cure under therapy.
2.2
2.2. Analysis
Comparison 2 Oral versus switch therapy, Outcome 2 Clinical and bacteriological cure at end of treatment.
2.3
2.3. Analysis
Comparison 2 Oral versus switch therapy, Outcome 3 Reinfection at end of treatment.
2.4
2.4. Analysis
Comparison 2 Oral versus switch therapy, Outcome 4 Relapse at end of treatment.
2.5
2.5. Analysis
Comparison 2 Oral versus switch therapy, Outcome 5 Clinical and bacteriological cure rate after interval.
2.6
2.6. Analysis
Comparison 2 Oral versus switch therapy, Outcome 6 Reinfection after interval.
2.7
2.7. Analysis
Comparison 2 Oral versus switch therapy, Outcome 7 Relapse after interval.
2.8
2.8. Analysis
Comparison 2 Oral versus switch therapy, Outcome 8 Renal scarring (DMSA scan) after 6 months.
2.9
2.9. Analysis
Comparison 2 Oral versus switch therapy, Outcome 9 Mean time to cessation of fever (hours).
2.10
2.10. Analysis
Comparison 2 Oral versus switch therapy, Outcome 10 Adverse events.
3.1
3.1. Analysis
Comparison 3 Oral versus parenteral therapy, Outcome 1 Bacteriological cure at end of treatment.
3.2
3.2. Analysis
Comparison 3 Oral versus parenteral therapy, Outcome 2 Bacteriological cure after interval.
4.1
4.1. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 1 Clinical cure under therapy.
4.2
4.2. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 2 Bacterial cure under therapy.
4.3
4.3. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 3 Mean time to cessation of fever (days).
4.4
4.4. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 4 Mean time of clinical symptoms (days).
4.5
4.5. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 5 Clinical cure at end of therapy.
4.6
4.6. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 6 Bacterial cure at end of therapy.
4.7
4.7. Analysis
Comparison 4 Single shot/oral versus switch therapy, Outcome 7 Adverse events.
5.1
5.1. Analysis
Comparison 5 Single shot/oral versus oral therapy, Outcome 1 Clinical and bacteriological cure under therapy.
5.2
5.2. Analysis
Comparison 5 Single shot/oral versus oral therapy, Outcome 2 Bacteriological cure under therapy.
5.3
5.3. Analysis
Comparison 5 Single shot/oral versus oral therapy, Outcome 3 Reinfection or relapse after interval.
5.4
5.4. Analysis
Comparison 5 Single shot/oral versus oral therapy, Outcome 4 Adverse events.
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Update of

References

References to studies included in this review

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References to other published versions of this review

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