scholarly journals The Clinical Efficacy of Nitrofurantoin for Treating Uncomplicated Urinary Tract Infection in Adults: A Systematic Review of Randomized Control Trials

2021 ◽  
pp. 1-10 ◽  
Author(s):  
Angelo Porreca ◽  
Daniele D’Agostino ◽  
Daniele Romagnoli ◽  
Francesco Del Giudice ◽  
Martina Maggi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Side Effects ◽  
High Risk ◽  
Risk Of Bias ◽  
Randomized Control Trials ◽  
Bacteriological Cure ◽  
Randomized Control ◽  
Tract Infections ◽  
Cure Rates

<b><i>Objective:</i></b> To provide an updated systematic review of randomized control trials (RCTs) to investigate the clinical and microbiological efficacy of nitrofurantoin compared to other antibiotics or placebo for treatment of uncomplicated urinary tract infections (uUTI). A secondary aim is to assess whether nitrofurantoin use is associated with increased side effects compared to other treatment regimens. <b><i>Summary:</i></b> The review was performed according to PRISMA guidelines. We searched 4 databases for articles published from database inception to May 6, 2020: (1) PubMed electronic database of the National Library of Medicine, (2) Web of Science, (3) Embase, and (4) Cochrane Library. Nine RCTs were selected for the review. RCTs were a mixture of double-blind, single-blind, and open-label trials. The most common comparators were trimethoprim-sulfamethoxazole and fosfomycin tromethamine. Overall study quality was poor with a high risk of bias. The clinical cure rates in nitrofurantoin ranged from 51 to 94% depending on the length of follow-up, and bacteriological cure rates ranged from 61 to 92%. Overall the evidence suggests that nitrofurantoin is at least comparable with other uUTI treatments in terms of efficacy. Patients taking nitrofurantoin reported fewer side effects than other drugs and the most commonly reported were gastrointestinal and central nervous system symptoms. <b><i>Key Messages:</i></b> Evidence on the clinical and bacteriological efficacy of nitrofurantoin is sparse, with a lack of new data, and hampered by high risk of bias. Although no firm conclusions can be made on the current base of evidence, the studies generally suggest that nitrofurantoin is at least comparable to other common uUTI treatments in terms of clinical and bacteriological cure. More robust research with well-designed double-blinded RCTs is needed.

scholarly journals Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis

2020 ◽  
Vol 70 (692) ◽  
pp. e200-e207 ◽  
Author(s):  
Anna Mae Scott ◽  
Justin Clark ◽  
Chris Del Mar ◽  
Paul Glasziou
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Primary Outcome ◽  
Fluid Intake ◽  
Risk Of Bias ◽  
Antimicrobial Use ◽  
Recurrent Utis ◽  
Tract Infections

BackgroundApproximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AimTo assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).Design and settingA systematic review.MethodThe authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.ResultsEight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.ConclusionGiven the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

Is the efficacy of antibiotic prophylaxis for surgical procedures decreasing? Systematic review and meta-analysis of randomized control trials

2018 ◽  
Vol 40 (2) ◽  
pp. 133-141 ◽  
Author(s):  
Sumanth Gandra ◽  
Anna Trett ◽  
Gerardo Alvarez-Uria ◽  
Joseph S. Solomkin ◽  
Ramanan Laxminarayan
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Cesarean Section ◽  
Antibiotic Prophylaxis ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Randomized Control Trials ◽  
Postoperative Infections ◽  
Randomized Control ◽  
Tract Infections

AbstractObjectiveRising antibiotic resistance could reduce the effectiveness of antibiotics in preventing postoperative infections. We investigated trends in the efficacy of antibiotic prophylaxis regimens for 3 commonly performed surgical procedures—appendectomy, cesarean section, and colorectal surgery—and 1 invasive diagnostic procedure, transrectal prostate biopsy (TRPB).DesignSystematic review and meta-analysis.MethodsWe searched PubMed and Cochrane databases (through October 31, 2017) for randomized control trials (RCTs) that measured the efficacy of antibiotic prophylaxis for 4 index procedures in preventing postoperative infections (surgical site infections [SSIs] following the 3 surgical procedures and a combination of urinary tract infections [UTIs] and sepsis following TRPB).ResultsOf 399 RCTs, 74 studies (9 appendectomy, 11 cesarean section, 39 colorectal surgery, and 15 TRPB) were included. Multilevel logistic regression models with random intercepts for each study showed no statistically significant increase in SSIs over time for appendectomy (adjusted odds ratio [aOR] per year, 1.03; 95% confidence interval [CI], 0.92–1.16; P=.57), cesarean section (aOR per year, 1.01; 95% CI, 0.96–1.05; P=.80), and TRPB (aOR per year, 0.95; 95% CI, 0.77–1.18; P=.67). However, there was a significant increase in SSIs proportion following colorectal surgery (aOR per year, 1.049; 95% CI, 1.03–1.07; P<.001).ConclusionThe efficacy of antibiotic prophylaxis agents in preventing SSIs following colorectal surgery has declined. Small number of RCTs and low infections rates limited our ability to assess true effect for simple appendectomy, cesarean section, or TRPB.

scholarly journals Antibiotics and Cure Rates in Childhood Febrile Urinary Tract Infections in Clinical Trials: A Systematic Review and Meta-analysis

Drugs ◽  
2018 ◽  
Vol 78 (15) ◽  
pp. 1593-1604 ◽  
Author(s):  
Konstantinos Vazouras ◽  
Romain Basmaci ◽  
Julia Bielicki ◽  
Laura Folgori ◽  
Theoklis Zaoutis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Meta Analysis ◽  
Febrile Urinary Tract Infections ◽  
Tract Infections ◽  
Cure Rates

90: A Systematic Review of Urinary Tract Infections Following Transposition of Bowel Segments into Urinary Tract

2004 ◽  
Vol 171 (4S) ◽  
pp. 24-24 ◽  
Author(s):  
Nabi Ghulam ◽  
Sze M. Yong ◽  
Eng Ong ◽  
Adrian Grant ◽  
Gladys C. McPherson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Tract Infections ◽  
Bowel Segments
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