scholarly journals Efficacy and safety of quinolones for the treatment of uncomplicated urinary tract infections in women: a network meta-analysis

2019 ◽  
Author(s):  
Alejandro G Gonzalez-Garay ◽  
Liliana Velasco-Hidalgo ◽  
Eric Ochoa-Hein ◽  
Roberto Rivera-Luna
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Adverse Events ◽  
Treatment Duration ◽  
Meta Analysis ◽  
Uncomplicated Urinary Tract Infection ◽  
Efficacy And Safety ◽  
Menopausal Women ◽  
Tract Infections

Abstract Background Uncomplicated urinary tract infection is considered an infection that occurs in healthy individuals who have a normal urinary tract, representing 5% of all annual medical visits. Several quinolones are available as second-line agents for treatment; however, we do not know which is the best antibiotic scheme for urinary tract infection; therefore, we conducted a network meta-analysis to hierarchize each quinolone according to its efficacy and safety. Methods MEDLINE, EMBASE and other databases were subjected to non-language-restricted searches up to 2018 for trials that included women treated with quinolones for uncomplicated urinary tract infection. Bias in the trials was assessed by two reviewers; the Cochrane Collaboration tool was used to analyze clinical and bacteriological remission, relapse, resistance, and adverse events. For direct comparisons, we obtained risk ratios and 95% confidence intervals by applying a fixed events model using Tau2 and Q2 tests to calculate the heterogeneity using trimethoprim/sulfamethoxazole as the common comparator across studies. For the network meta-analysis, we analyzed the indirect comparisons by Bucher's method. The results were summarized in a correlation matrix. Results We included 18 trials with 8765 women. For pre-menopausal women and treatment duration <3 days, norfloxacin and ofloxacin had a 57% of probability for achieving remission but with an 83% frequency of adverse events. For post-menopausal women, ciprofloxacin and ofloxacin were 82% more effective for remission with an 49% frequency of adverse events compared with other types of quinolones. Conclusions Compared with other quinolones, ofloxacin (200 mg) was more effective for remission, although with a high probability of adverse events; however, norfloxacin (400 mg) could be an alternative in treatment, due to it low probability of adverse events; even though additional trials are needed to confirm our findings, especially in treatment duration exceeds 3 days. PROSPERO registration CRD42015025886

scholarly journals Antibacterial data synthesis challenges: a systematic review of treatments for complicated gram-negative urinary tract infections

2021 ◽  
Author(s):  
Ryan Dillon ◽  
Jennifer Uyei ◽  
Rajpal Singh ◽  
Eilish McCann
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Meta Analysis ◽  
Complicated Urinary Tract Infection ◽  
Clinical Trial Data ◽  
Patient Characteristics ◽  
Heterogeneous Data ◽  
Eligibility Criteria ◽  
Tract Infections

Aim: To determine the suitability of network meta-analysis (NMA) using antibacterial treatment evidence in complicated urinary tract infection. Materials & methods: We conducted a systematic literature review to identify published clinical trial data for complicated urinary tract infection treatments. We performed a feasibility assessment to determine whether the available evidence would support the creation of a robust NMA, considering key assumptions of homogeneity, similarity and consistency. Results: Twenty-five trials met eligibility criteria. Risk of bias was low, and individual studies met their primary end point(s). Assumptions central to the conduct of a robust NMA were not met. Heterogeneity was ubiquitous, including baseline pathogen, treatment and patient characteristics. Conclusion: Limited and heterogeneous data identified make the use of NMA to compare novel antibacterial agents impractical and likely unreliable.

Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients

2020 ◽  
Vol 54 (8) ◽  
pp. 757-766
Author(s):  
Titilola M. Afolabi ◽  
Kellie J. Goodlet ◽  
Kathleen A. Fairman
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Treatment ◽  
Treatment Duration ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Uncomplicated Urinary Tract Infection ◽  
Antibiotic Treatment Duration ◽  
New Onset

Background: Gaps and inconsistencies in published information about optimal antibiotic treatment duration for uncomplicated urinary tract infection (UTI) in pediatric patients pose a dilemma for antibiotic stewardship. Objective: Evaluate the association of antibiotic treatment duration with recurrence rates in children with new-onset cystitis or pyelonephritis. Methods: Retrospective cohort analysis of patients aged 2 to 17 years with new-onset cystitis or pyelonephritis and without renal/anatomical abnormality was conducted using Truven Health MarketScan Database for 2013-2015. Results: Of 7698 patients, 85.5% had cystitis, 14.3% pyelonephritis. Duration of antibiotic treatment was as follows: 3 to 5 days for cystitis (20.4%) or 7 (33.6%), 10 (44.2%), or 14 (1.8%) days for any UTI. Recurrence occurred in 5.5% of patients. Covariates associated with increased recurrence risk included pretreatment antibiotic exposure (odds ratio [OR] = 1.29; 95% CI = 1.06-1.57), pyelonephritis on diagnosis date (OR = 1.44; 95% CI = 1.03-2.00), follow-up visit during antibiotic treatment (OR = 3.21; 95% CI = 2.20-4.68), parenteral antibiotic (OR = 1.89; 95% CI = 1.33-2.69), and interaction of pyelonephritis diagnosis with nitrofurantoin monotherapy (OR = 3.68; 95% CI = 1.20-11.29). After adjustment for covariates, the association between duration of antibiotic treatment and recurrence was not significant (compared with 7 days: 10 days: OR = 1.07, 95% CI = 0.85-1.33; 14 days: OR = 0.89, 95% CI = 0.45-1.78). Conclusions and Relevance: Antibiotic treatment duration was not significantly associated with recurrence of uncomplicated UTI in a national pediatric cohort. Results provide support for shorter-course treatment, consistent with antimicrobial stewardship efforts.

scholarly journals Cranberries for women with recurrent urinary tract infection: a meta-analysis

2019 ◽  
Vol 28 (3) ◽  
pp. 268-75
Author(s):  
Made Parulian Tambunan ◽  
Harrina Erlianti Rahardjo
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Adverse Events ◽  
Recurrent Urinary Tract Infection ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Assessment Tools ◽  
Adherence Rate ◽  
Good Adherence

BACKGROUND Cranberries are the most widely used nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI) in women; however, their efficacy still remains uncertain. Hence, this meta-analysis was aimed to assess the effectiveness, safety, and adherence of cranberry as a prophylactic drug for treating rUTI. METHODS Literature search was conducted using PubMed, EBSCO, Science Direct, Scopus, Cochrane, and Google Scholar. Studies were screened for duplication, inclusion and exclusion criteria, and then reviewed by two authors independently. This included all randomized controlled trials of cranberry derivatives versus placebo and antibiotic prophylaxis. Cochrane risk-of-bias assessment tools were used to evaluate the quality of the study. Quantitative analysis was performed using the Review Manager 5.0 software. RESULTS Nine studies were included. Among 1,542 participants, cranberry consumption reduced incidence of rUTI in women compared with placebo (p = 0.02). The subgroup analysis revealed that only cranberry capsules were superior to placebo (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.45–0.98), but not for cranberry juice (RR = 0.85, 95% CI: 0.7–1.04). Antibiotics had better outcome than cranberry for rUTI (RR = 0.83, 95% CI = 0.70–0.98). Most of the participants experienced minor adverse events such as rash and gastrointestinal symptoms. There was also a good adherence rate, ranging from 90.3–99% monthly dose. CONCLUSIONS Cranberry, especially cranberry capsule consumption, had a significant effect in reducing the incidence of rUTI compared with placebo, with good adherence rates, and minor adverse events. In contrast, although antibiotic use had a greater efficacy, it was associated with a higher risk of severe adverse events.

Comparative Trial of Two Sulfisoxazole Regimens in Acute Urinary Tract Infection

1981 ◽  
Vol 15 (11) ◽  
pp. 863-866
Author(s):  
Randall A. Prince ◽  
Deborah H. Cassel ◽  
Charles D. Hepler ◽  
James L. Wilson ◽  
Mark E. Jones ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Comparative Trial ◽  
Uncomplicated Urinary Tract Infection ◽  
Loading Dose ◽  
Presenting Symptoms ◽  
Significant Difference ◽  
Tract Infections ◽  
Acute Urinary Tract Infection

Traditionally, the therapeutic regimen of sulfisoxazole in acute urinary tract infection has included either a 2- or 4-g loading dose. However, the biopharmaceutical aspects of this drug indicate that a loading dose is unnecessary. The objective of this clinical study, therefore, was to compare a traditional regimen of sulfisoxazole to a regimen not utilizing a loading dose. Fifty adult female patients with acute, uncomplicated urinary tract infections were assigned to a ten-day course of sulfisoxazole 1 g po qid. Patients were randomly allocated to a 2-g loading dose or no loading dose regimen. Data were analyzed with regard to resolution of presenting symptoms and eradication of the infecting organism (i.e., cure). Statistical analysis demonstrated no significant difference for symptom resolution and cure. It appears that the convention of using an initial 2-g oral loading dose of sulfisoxazole in the treatment of acute, uncomplicated urinary tract infection is unwarranted.

scholarly journals Systematic Review and Meta-Analysis of Antimicrobial Treatment Effect Estimation in Complicated Urinary Tract Infection

2013 ◽  
Vol 57 (11) ◽  
pp. 5284-5290 ◽  
Author(s):  
Krishan P. Singh ◽  
Gang Li ◽  
Fanny S. Mitrani-Gold ◽  
Milena Kurtinecz ◽  
Jeffrey Wetherington ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Treatment Effect ◽  
Meta Analysis ◽  
Complicated Urinary Tract Infection ◽  
Antimicrobial Treatment ◽  
Uncomplicated Urinary Tract Infection ◽  
Noninferiority Trial

ABSTRACTNoninferiority trial design and analyses are commonly used to establish the effectiveness of a new antimicrobial drug for treatment of serious infections such as complicated urinary tract infection (cUTI). A systematic review and meta-analysis were conducted to estimate the treatment effects of three potential active comparator drugs for the design of a noninferiority trial. The systematic review identified no placebo trials of cUTI, four clinical trials of cUTI with uncomplicated urinary tract infection as a proxy for placebo, and nine trials with reports of treatment effect estimates for doripenem, levofloxacin, or imipenem-cilastatin. In the meta-analysis, the primary efficacy endpoint of interest was the microbiological eradication rate at the test-of-cure visit in the microbiological intent-to-treat population. The estimated eradication rates and corresponding 95% confidence intervals (CI) were 31.8% (26.5% to 37.2%) for placebo, 81% (77.7% to 84.2%) for doripenem, 79% (75.9% to 82.2%) for levofloxacin, and 80.5% (71.9% to 89.1%) for imipenem-cilastatin. The treatment effect estimates were 40.5% for doripenem, 38.7% for levofloxacin, 34.7% for imipenem-cilastatin, and 40.8% overall. These treatment effect estimates can be used to inform the design and analysis of future noninferiority trials in cUTI study populations.

scholarly journals 1415. Allergies to Antimicrobial Agents Among US Females with Uncomplicated Urinary Tract Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S792-S793
Author(s):  
Jeffrey Thompson ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Jonathon Wright ◽  
Ashish V Joshi
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antimicrobial Agents ◽  
Oral Treatment ◽  
Treatment Options ◽  
Complicated Urinary Tract Infection ◽  
Uncomplicated Urinary Tract Infection ◽  
Cross Sectional Survey ◽  
Tract Infections

Abstract Background Uncomplicated urinary tract infections (uUTI) are generally treated empirically with antibiotics. However, antibiotic (AB) allergies limit the available oral treatment options for some patients. We assessed the proportion of self-reported AB allergies among US females with uUTI. Methods We performed a cross-sectional survey of US females ≥ 18 years of age with a self-reported urinary tract infection (UTI) in the 60 days prior to participation and a prescription of oral AB. Participants were further screened for evidence of a complicated urinary tract infection and, after exclusions, participants with a uUTI completed an online questionnaire about their most recent episode. Participants were from the Northeast (20%), Midwest (44%), South (20%), and West (16%) US. Descriptive self-reported allergy data were stratified into subgroups by whether the participant had recurrent UTI (defined as ≥ 2 uUTIs in the past 6 months or ≥ 3 uUTIs in past 12 months including index UTI), the number of different ABs given for the index episode (1, 2, ≥ 3), and whether the treatment was clinically appropriate according to Infectious Diseases Society of America uUTI guidelines. Results Overall, 375 female participants completed the questionnaire. The most commonly prescribed ABs for participants’ most recent uUTI were trimethoprim-sulfamethoxazole (TMP-SMX; 38.7%), ciprofloxacin (22.7%), and nitrofurantoin (18.9%) (Table 1). Most participants received only 1 AB for their uUTI (62.7%) and the majority were classified as having a non-recurrent uUTI (56.5%). No AB allergies were reported for most participants (69.3%); overall, 24.0% reported 1 AB allergy and 6.7% reported ≥ 2. A higher proportion of participants reported ≥ 2 allergies in the recurrent uUTI, ≥ 3 AB, and multiple AB subgroups (Table 2). The most common allergy was to TMP-SMX (15.7%), followed by amoxicillin-clavulanate (8.3%) and ciprofloxacin (5.3%) (Table 2). Similar allergy trends were seen across subgroups, except higher rates of ciprofloxacin allergy were seen in participants given multiple ABs (Table 2). Table 1. Antibiotics used to treat most recent uUTI Table 2 . Frequency of antibiotic allergies across cohort subgroups Conclusion AB allergies were relatively frequent in this uUTI cohort and the most common allergy was to TMP-SMX, which was the most prescribed AB. Allergies to ABs reduce the available treatment options for uUTI in some patients. Disclosures Jeffrey Thompson, PhD, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Jonathon Wright, BSc, Kantar Health (Employee, Employee of Kantar Health, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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