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Meta-Analysis
. 2010 Oct 6;2010(10):CD007182.
doi: 10.1002/14651858.CD007182.pub2.

Antimicrobial agents for treating uncomplicated urinary tract infection in women

Anca Zalmanovici Trestioreanu  1 , Hefziba Green, Mical Paul, John Yaphe, Leonard Leibovici
Affiliations
Meta-Analysis

Antimicrobial agents for treating uncomplicated urinary tract infection in women

Anca Zalmanovici Trestioreanu et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute uncomplicated lower urinary tract infection (UTI) is one of the most common problems for which young women seek medical attention.

Objectives: To compare the efficacy, resistance development and safety of different antimicrobial treatments for acute uncomplicated lower UTI.

Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's Specialised Register, MEDLINE, EMBASE and bibliographies of included studies.

Selection criteria: Randomised controlled trials (RCTs) comparing different classes of antimicrobials for acute uncomplicated UTI in women were included. The outcomes of interest were symptomatic and bacteriological cure at short and long-term follow-up, resistance development, number of days to symptom resolution, days of work loss, adverse events and complications.

Data collection and analysis: Two authors independently extracted the data and assessed study quality. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI).

Main results: Trimethoprim-sulfamethoxazole (TMP-SMX) was as effective as fluoroquinolones in achieving short-term (RR 1.00, 95% CI 0.97 to 1.03) and long-term (RR 0.99, 95% CI 0.94 to 1.05) symptomatic cure. Beta-lactam drugs were as effective as TMP-SMX for short-term (RR 0.95' 95% CI 0.81 to 1.12) and long-term (RR 1.06' 95% CI 0.93 to 1.21) symptomatic cure. Short-term cure for nitrofurantoin was similar to that of TMP-SMX (RR 0.99' 95% CI 0.95 to 1.04) as was long-term symptomatic cure (RR 1.01' 95% CI 0.94 to 1.09).Fluoroquinolones were more effective than beta-lactams (RR 1.22, 95% CI 1.13 to 1.31) for short-term bacteriological cure. Rashes were more frequent in patients treated with TMP-SMX than with nitrofurantoin or fluoroquinolones and in patients treated with beta-lactam drugs compared to fluoroquinolones. Minimal data were available on the emergence of resistant strains during or after antimicrobial treatment.

Authors' conclusions: No differences were observed between the classes of antimicrobials included in this review for the symptomatic cure of acute uncomplicated UTI. Fluoroquinolones proved more effective than beta-lactams for the short-term bacteriological outcome, probably with little clinical significance. Individualised treatment should take into consideration the predictable susceptibility of urinary pathogens in local areas, possible adverse events and resistance development, and patient preference.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 1 Short‐term symptomatic cure.
1.2
1.2. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 2 Short‐term symptomatic cure: susceptible pathogens.
1.3
1.3. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 3 Long‐term symptomatic cure.
1.4
1.4. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 4 Short‐term bacteriological cure.
1.5
1.5. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 5 Short‐term bacteriological cure: susceptible pathogens.
1.6
1.6. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 6 Long‐term bacteriological cure.
1.7
1.7. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 7 Resistance development.
1.8
1.8. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 8 Any adverse event requiring discontinuation of treatment.
1.9
1.9. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 9 Adverse events.
1.10
1.10. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 10 Complications: pyelonephritis.
1.11
1.11. Analysis
Comparison 1 Fluoroquinolone versus TMP‐SMX, Outcome 11 ITT analyses.
2.1
2.1. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 1 Short‐term symptomatic cure.
2.2
2.2. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 2 Long‐term symptomatic cure.
2.3
2.3. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 3 Short‐term bacteriological cure.
2.4
2.4. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 4 Short‐term bacteriological cure: susceptible pathogens.
2.5
2.5. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 5 Long‐term bacteriological cure.
2.6
2.6. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 6 Resistance development.
2.7
2.7. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 7 Any adverse event requiring discontinuation of treatment.
2.8
2.8. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 8 Adverse events.
2.9
2.9. Analysis
Comparison 2 Beta‐lactam versus TMP‐SMX, Outcome 9 ITT analyses.
3.1
3.1. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 1 Short‐term symptomatic cure.
3.2
3.2. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 2 Short‐term bacteriological cure.
3.3
3.3. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 3 Short‐term bacteriological cure: susceptible pathogens.
3.4
3.4. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 4 Long‐term bacteriological cure.
3.5
3.5. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 5 Any adverse event requiring discontinuation of treatment.
3.6
3.6. Analysis
Comparison 3 Nitrofurantoin versus beta‐lactam, Outcome 6 Adverse events.
4.1
4.1. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 1 Short‐term symptomatic cure.
4.2
4.2. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 2 Long‐term symptomatic cure.
4.3
4.3. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 3 Short‐term bacteriological cure.
4.4
4.4. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 4 Short‐term bacteriological cure: susceptible pathogens.
4.5
4.5. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 5 Long‐term bacteriological cure.
4.6
4.6. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 6 Resistance development.
4.7
4.7. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 7 Any adverse event requiring discontinuation of treatment.
4.8
4.8. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 8 Adverse events.
4.9
4.9. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 9 Complications: pyelonephritis.
4.10
4.10. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 10 ITT analyses.
4.11
4.11. Analysis
Comparison 4 Fluoroquinolone versus beta‐lactam, Outcome 11 Sensitivity analysis: adequate allocation concealment.
5.1
5.1. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 1 Short‐term symptomatic cure.
5.2
5.2. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 2 Long‐term symptomatic cure.
5.3
5.3. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 3 Short‐term bacteriological cure.
5.4
5.4. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 4 Short‐term bacteriological cure: susceptible pathogens.
5.5
5.5. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 5 Long‐term bacteriological cure.
5.6
5.6. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 6 Resistance development.
5.7
5.7. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 7 Any adverse event requiring discontinuation of treatment.
5.8
5.8. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 8 Adverse events.
5.9
5.9. Analysis
Comparison 5 Nitrofurantoin versus TMP‐SMX, Outcome 9 ITT analyses.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

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