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Reappraisal of Single-Dose Antibiotic Treatment for Uncomplicated Urinary Tract Infection in Adult Women: A Systematic Review and Network Meta-Analysis of 58 Randomized Clinical Trials

42 Pages Posted: 15 May 2019

See all articles by Do Kyung Kim

Do Kyung Kim

Soonchunhyang University - Department of Urology

Jae Hung Jung

Yonsei University - Department of Urology

Jae Heon Kim

Soonchunhyang University - Department of Urology; Soonchunhyang University - Biomedical Urology Research Institute

Nam Su Ku

Yonsei University - Department of Internal Medicine

Joo Yong Lee

Yonsei University - Department of Urology

Jong Won Kim

Yonsei University - Department of Urology

Kwang Joon Kim

Yonsei University - Division of Geriatrics

Kang Su Cho

Yonsei University - Department of Urology

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Abstract

Background: This systematic review and network meta-analysis of randomized clinical trials (RCTs) was conducted to reappraise the efficacies of various antibiotic regimens for the treatment of uncomplicated urinary tract infection (UTI), with a particular focus on single-dose therapies.

Methods: The PubMed/Medline, Embase, and Cochrane Library databases were searched for relevant publications up to April 2018. Subsequently, the identified trials were evaluated for eligibility using the PICOS (participants, interventions, comparators, outcomes, and study design) approach according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Moreover, the efficacies of each antibiotic treatment regimen in terms of clinical and microbial responses were directly and indirectly compared.

Findings: This analysis included 58 prospective RCTs (19,527 patients) with at least two arms that compared the efficacies of several antibiotic regimens, including placebo effect, in female patients with uncomplicated UTI. Notably, all antibiotic therapy regimens except amoxicillin single-dose and nitrofurantoin 3-days were significantly more effective than placebo with respect to clinical responses, while all except 1st-generation cephalosporin single-dose and nitrofurantoin 3-day treatments were more effective in terms of microbial responses. Notably, 2nd-, 3rd-, and 4th-generation fluoroquinolone; fosfomycin trometamol; trimethoprim-sulfamethoxazole; 3rd-generation cephalosporin; and amoxicillin/clavulanic acid single-dose therapies yielded more effective clinical and microbial responses, compared to placebo.

Interpretation: Our meta-analysis showed that most single-dose therapies were not inferior to longer-duration antibiotic regimens. Although appropriate antibiotics for uncomplicated UTI should be determined based on preceding studies of local drug resistance, the potential benefits and uses of single-dose therapy should be reconsidered.

Funding Statement: This study was supported by a faculty research grant from the Yonsei University College of Medicine (6-2018-0043).

Declaration of Interests: The authors have nothing to disclose.

Ethics Approval Statement: The authors used the PRISMA framework to analyze and summarize our systematic analysis and meta-review process. This systematic review was registered in PROSPERO (CRD42018093529).

Keywords: uncomplicated; lower urinary tract infection; women; antibiotic; network meta-analysis

Suggested Citation

Kim, Do Kyung and Jung, Jae Hung and Kim, Jae Heon and Ku, Nam Su and Lee, Joo Yong and Kim, Jong Won and Kim, Kwang Joon and Cho, Kang Su, Reappraisal of Single-Dose Antibiotic Treatment for Uncomplicated Urinary Tract Infection in Adult Women: A Systematic Review and Network Meta-Analysis of 58 Randomized Clinical Trials (May 10, 2019). Available at SSRN: https://ssrn.com/abstract=3386296 or http://dx.doi.org/10.2139/ssrn.3386296

Do Kyung Kim

Soonchunhyang University - Department of Urology

Seoul
Korea, Republic of (South Korea)

Jae Hung Jung

Yonsei University - Department of Urology

Wonju
Korea, Republic of (South Korea)

Jae Heon Kim

Soonchunhyang University - Department of Urology

Seoul
Korea, Republic of (South Korea)

Soonchunhyang University - Biomedical Urology Research Institute ( email )

Korea, Republic of (South Korea)

Nam Su Ku

Yonsei University - Department of Internal Medicine

Seoul
Korea, Republic of (South Korea)

Joo Yong Lee

Yonsei University - Department of Urology

Seoul
Korea, Republic of (South Korea)

Jong Won Kim

Yonsei University - Department of Urology

Seoul
Korea, Republic of (South Korea)

Kwang Joon Kim

Yonsei University - Division of Geriatrics

Seoul
Korea, Republic of (South Korea)

Kang Su Cho (Contact Author)

Yonsei University - Department of Urology

Seoul
Korea, Republic of (South Korea)

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