DARE: Search Results
Document: 7
Single-dose antibiotic treatment for symptomatic urinary tract infections in
women: a meta-analysis of randomized trials
Leibovici L, Wysenbeek A J..
Single-dose antibiotic treatment for symptomatic urinary tract infections in
women: a meta-analysis of randomized trials
Quarterly Journal of Medicine,
1991,
285,
pp.43-57
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To compare the efficacy and rate of side effects of single-dose versus
conventional antibiotic treatment of urinary tract infection. Type of
intervention
Treatment
Specific interventions included in the review
Single dose oral antibiotics (amoxicillin, bacampicilin, cefaclor, cefadroxil,
cefuroxime, doxycycline, nitrofurantoin, pefloxacin, pivnecilinam,
trimethoprim/sulfamethoxazole (TMP/SMZ)). Conventional (five days or more)
treatment with antibiotics.
Participants included in the review
Adult ambulatory women with symptomatic, uncomplicated urinary tract
infections (defined as a growth of more than 10,000 cfu/ml from midstream
urine or any bacterial growth in urine obtained by catheterisation or
supra-pubic aspiration in patients with urinary complaints). A study involving
only adolescent girls and a study involving only elderly women were not
included.
Outcomes assessed in the review
Cure rates (percentage of available patients with negative urine cultures) at
3-14 days and at 4-6 weeks post treatment.
Study designs of evaluations included in the review
Randomised controlled trials.
What sources were searched to identify primary studies?
MEDLINE and Index Medicus (computerised and manual searches - no search
strategy given, no date limits for searches given). Bibliographies of
relevant articles and reviews. Contact with investigators.
Criteria on which the validity (or quality) of studies was assessed
Not stated. The authors report that only two of the included studies were
performed double blind.
How were the judgements of validity (or quality) made?
Not stated.
How were decisions on the relevence of primary studies made?
Not stated.
How was the data extracted from primary studies?
Not stated.
Number of studies included
25 randomised controlled trials involving 2397 patients. Two of the trials
were double blind.
How were the studies combined?
Pooled odds ratios were calculated using a fixed effects model.
How were differences between studies investigated?
Chi squared tests were used to assess heterogeneity. Studies which involved
only patients with isolates susceptible to the antibiotics being tested were
considered separately.
Results of the review
Odds ratios for cure rates with any single dose antibiotic compared with
conventional treatment: 3-14 days post treatment, all isolates (16 trials):
0.49 (95%CI: 0.36, 0.67, p<0.01) 3-14 days post treatment, susceptible
isolates (20 trials): 0.47 (95%CI: 0.34, 0.65, p<0.01) 4-6 weeks post
treatment, all isolates (10 trials): 0.44 (95%CI: 0.31, 0.62, p<0.01) 4-6
weeks post treatment, susceptible isolates (11 trials): 0.54 (95%CI: 0.39,
0.75, p<0.01)
Odds ratios for cure rates with amoxicilin, single dose compared with
conventional treatment: 3-14 days post treatment, all isolates (4 trials):
0.40 (95%CI: 0.24, 0.66, p<0.01) 4-6 weeks post treatment, all isolates (2
trials): 0.53 (95%CI: 0.21, 1.30, NS)
Odds ratios for cure rates with TMP/SMZ, single dose compared with
conventional treatment: 3-14 days post treatment, all isolates (7 trials):
0.71 (95%CI: 0.42, 1.19, NS) 4-6 weeks post treatment, all isolates (5
trials): 0.48 (95%CI: 0.30, 0.77, p<0.01)
Reported incidence of side effects ranged from 0 - 25% in patients given a
single dose, and from 0 - 44% in patients given conventional therapy. Odds
ratios for different side effects with single dose antibiotic compared with
conventional therapy: Gastro-intestinal complaints: 0.98 (NS)
Vaginitis/vaginal discharge: 0.46 (p<0.01) Skin rashes: 0.28 (p<0.01) Other
side effects: 0.36 (p<0.01) Total side effects: 0.46 (p<0.01)
Was any cost information reported?
No.
Author's conclusions
Single dose antibiotic treatment of urinary tract infection in women is less
effective than conventional treatment, but causes fewer side effects.
CRD commentary
This review addressed clear, focused questions using appropriate methods. The
addition of a search of EMBASE to the search strategy might have identified
more studies. Susceptibility to bias might have been further ruled out if it
was clear that decisions about the inclusion of studies and data extraction
had been made by more than person or checked. The authors point out that in
order to answer the question of whether the use of single-dose antibiotics is
advisable in women with uncomplicated symptomatic urinary tract infection, we
need to consider the issue of the potential ecological advantage of single
dose treatment and the implications of the failure of single dose treatments
on patients.
Subject index terms
Subject indexing assigned by NLM: Antibiotics/ad [administration-and-dosage];
Urinary-Tract-Infections/dt [drug-therapy] Antibiotics/ae [adverse effects];
Drug-Combinations; Sulfamethoxazole/ad [administration-and-dosage];
Treatment-Outcome; Trimethoprin/ad [administration-and-dosage]
Correspondence address
L Leibovici, MD, Internal Medicine Dept B, Beilinson Medical Center, 49 100
Petah Tiqva, Israel
Copyright
University of York, 1998
Database no.: DARE-968073
