The use of chemotherapeutic agents as prophylaxis for recurrent urinary tract infection in healthy nonpregnant women: A network meta-analysis

Abstract

Introduction: The aim of this systematic review is to compare chemotherapeutic agents commonly used in treating recurrent urinary infection in nonpregnant women by their efficacy, tolerability, adverse effects, and cost employing network meta-analysis.

Materials and methods: We used three online databases, i.e., PubMed, ScienceDirect, and Cochrane Central Registry of Clinical Trials. Randomized controlled trials (RCTs) on the use of prophylactic chemotherapeutic agents used in treating nonpregnant women with recurrent urinary tract infections (RUTIs) published between 2002 and 2016 were selected. Only published papers in English were assessed for study quality, and meta-analyses were performed using fixed-effects model with NetMetaXL.

Results: Six RCTs fulfilled the criteria. When all three variables, i.e., efficacy, adverse effects and cost were considered, nitrofurantoin 50 mg once daily for 6 months appears to rank high for prophylaxis against RUTI. When efficacy was the only factor, fosfomycin had the highest superiority compared to D-mannose, nitrofurantoin, estriol, trimethoprim-sulfamethoxazole, and cranberry juice, respectively. However, fosfomycin was also ranked highest by adverse events. When cost alone is considered, nitrofurantoin appeared the most cost-effective agent while placed third for efficacy alone.

Conclusion: Selecting appropriate chemotherapeutic agents for RUTI will need to factor in effectiveness, adverse effects, and cost. While it is difficult to select an ideal drug, evaluation using network analysis may guide choice of medication for best practice.

Figure 1

Study design-preferred reporting items for systematic reviews and meta-analyses for protocols 2009 flow chart

Figure 2

Network analysis of drugs used treatment by sample size

Figure 3

Comparison of all drug intervention in terms of efficacy. Heterogenecity = 0.5125 95%CI (0.00122–1.876)

Figure 4

League table of drugs used in the recurrent urinary tract infection. D-mannose ranks highest with fosfomycin second and nitrofurantoin third

Figure 5

Comparison of all intervention in terms of adverse effects. By way of adverse effects, D-mannose ranks highest with estriol and cranberry lower. Better than estriol

Figure 6

League table of drugs in terms of adverse effects. Apart from placebo, cranberry is ranked highest in the league table [] with nitrofurantoin lowest indicating the latter is associated with more adverse effects than others though dropout rate was not an issue