Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 8;42(1):221.
doi: 10.1007/s00345-024-04922-5.

Antibiotics efficacy in clinical and microbiological cure of uncomplicated urinary tract infection: a systematic review and network meta-analysis

Mohammed F Hadidi #  1   2 , Nawaf Alhamami #  1   2 , Mohammed Alhakami  1   2 , Ahmed S Abdulhamid  3   4 , Abdullah Alsharif  1   2 , Mohammed S Alomari  1   2 , Yasir A Alghamdi  1   2 , Samirah Alshehri  5 , Abdullah A Ghaddaf  1   2 , Faisal M Alsenani  6 , Hisham Almadani  6
Affiliations

Antibiotics efficacy in clinical and microbiological cure of uncomplicated urinary tract infection: a systematic review and network meta-analysis

Mohammed F Hadidi et al. World J Urol. .

Abstract

Purpose: Fosfomycin has been used more frequently in managing uncomplicated urinary tract infections (UTIs) due to decreased compliance and increased multidrug-resistant bacteria. The aim of this network meta-analysis was to assess the efficacy of Fosfomycin compared to Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), and Ciprofloxacin in terms of clinical and microbiological cure alongside with other measurements.

Materials and methods: We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). We included randomized control trials (RCTs) with uncomplicated UTI patients who received Fosfomycin, Nitrofurantoin, TMP-SMX, or Ciprofloxacin and reported the clinical or microbiological cure. We used Cochrane Risk of Bias Assessment Tool to assess the included studies' quality. R-software was used for all statistical analysis. We ranked all antibiotics using the netrank function which yielded P scores. Frequentist network meta-analysis was used to assess the efficacy of all outcomes.

Results: We included 13 RCTs with a total number of 3856 patients that showed Fosfomycin ranked the highest among the other antibiotics with respect to clinical cure (P-score = 0.99) and microbiological cure (P-score = 0.99) while Ciprofloxacin ranked the lowest (P-score = 0.11 and 0.02, respectively). Moreover, Ciprofloxacin yielded the highest relapse rate (P-score = 1), whereas TMP-SMX had the lowest relapse rate (P-score = 0.07). As for the adverse events, Ciprofloxacin demonstrated the highest adverse events as opposed to Fosfomycin (P-score = 0.98 and 0.05, respectively).

Conclusion: The network meta-analysis demonstrated that Fosfomycin is the most effective antibiotic in treating uncomplicated UTIs with respect to clinical cure, microbiological cure, and adverse events profile.

Keywords: Ciprofloxacin; Fosfomycin; Nitrofurantoin; Trimethoprim–Sulfamethoxazole; Urinary tract infection.

PubMed Disclaimer

Comment in

References

    1. Wagenlehner FM, Hoyme U, Kaase M, Fünfstück R, Naber KG, Schmiemann G (2011) Uncomplicated urinary tract infections. Dtsch Arztebl Int 108(24):415 - PubMed - PMC
    1. Ceran N, Mert D, Kocdogan FY, Erdem I, Ozyurek S, Goktas P, Adalati R (2010) A randomized comparative study of single-dose fosfomycin and 5-day ciprofloxacin in female patients with uncomplicated lower urinary tract infections. J Infect Chemother 16(6):424–430 - DOI - PubMed
    1. Bono MJ, Leslie SW, Reygaert WC (2023) Uncomplicated urinary tract infections. In: StatPearls. StatPearls Publishing, Treasure Island (FL), PMID: 29261874
    1. Rowe TA, Juthani-Mehta M (2013) Urinary tract infection in older adults. Aging health 9(5):519–528 - DOI
    1. European Association of Urology (2023) EAU guidelines on urological infections

Publication types

MeSH terms

LinkOut - more resources