Meta-analyses in Prevention and Treatment of Urinary Tract Infections
Section snippets
Interventions to prevent urinary tract infections
Cranberries long have been advocated for the prevention and treatment of UTI. Cranberries contain mallic acid, citric acid, quinic acid, fructose, and glucose. It is thought that fructose and proancanthocyanidins inhibit adherence of type 1 and α-galactose–specific fimbriated Escherichia coli to the uroepithelial cell lining of the bladder. A role for urinary hippuric acid excretion has been somewhat discredited, with several studies showing cranberry to have no or only an extremely transient
Interventions to treat urinary tract infection
A range of antibiotics, with different rates of cure and varying side-effect profiles, are used in the treatment of UTI. It is unclear whether short-course therapies are as effective as longer-course regimens in inducing cure and in preventing relapse and also whether the route of administration affects these outcomes or the incidence of side effects. It also is unknown whether antibiotic class, treatment duration, and route of delivery affect treatment adherence and whether compliance in turn
Methods of literature review
In September 2008 the authors searched databases of the Cochrane Library and MEDLINE for systematic reviews of RCTs for the prevention and treatment of UTI in any patient population. Sensitive search strategies were devised by combining medical subject headings (MeSH) with text words for UTI, including “urinary tract infection,” “bacteriuria,” and “pyuria.” Terms specific for prevention interventions included “beverages,” “fruit,” “cranberries,” “vaccinium macrocarpon,” “vaccinium oxycoccus,”
Prevention of urinary tract infections in women
One systematic review including meta-analysis of four RCTs evaluated the effectiveness of either cranberry juice or another cranberry product versus placebo in diverse populations (Table 1).1 Of these, two RCTs exclusively enrolled women who had recurrent UTI; the other RCTs included elderly people aged over 60 years and patients who had at least a 12-month history of spinal cord injury and neurogenic bladder. The primary outcome of UTI was defined variably among trials and included symptomatic
Treatment of urinary tract infections in women
The authors identified no meta-analyses that compared different classes of antibiotics for treatment of UTI in women.
One systematic review investigated the optimal duration of antibiotic therapy for nonpregnant women under 65 years old and included 33 RCTs of 9605 women between the ages of 18 and 65 years who had uncomplicated UTI (see Table 1).3 RCTs compared short-course (3 days) with longer-course (5 to 10 days) antibiotics, although not all RCTs reported all outcomes of interest.
Prevention of urinary tract infections in pregnant women
One meta-analysis synthesized results from 11 RCTs comparing antibiotic prophylaxis versus placebo in pregnant women who had asymptomatic bacteriuria, and all 11 RCTs reported the development of pyelonephritis as an outcome (see Table 1).5 Among contributing RCTs, the duration of prophylaxis varied from a single dose to continuation of antibiotics until 6 weeks postpartum. A 77% reduction in the incidence of pyelonephritis was seen in the group receiving prophylactic antibiotics as compared
Treatment of urinary tract infections in pregnant women
The authors identified one systematic review that examined the effect of antibiotic class on UTI cure and recurrence rates in pregnant women who had symptomatic UTI, including nine RCTs with a total of 997 participants (see Table 1).6 Only four RCTs compared different antibiotic classes and reported outcomes of interest. Although each RCT used the same route of administration across RCT arms, and most RCTs used comparable durations of treatment, the interventions were varied, with different
Prevention of urinary tract infections in elderly people and other specific populations
There was no meta-analysis of prevention strategies including only elderly people or other populations. Of the four RCTs included in the meta-analysis of cranberry juice/cranberry product for the prophylaxis of UTI, one large RCT specifically recruited men and women over 60 years of age.1 The result of the meta-analysis of the four RCTs combined (n = 665) significantly favored the cranberry group (RR 0.66, 95% CI, 0.47–0.92, P = .01) (Table 2). Results for the RCT reporting only elderly people
Treatment of urinary tract infections in elderly people and other specific populations
One systematic review examined the effect of short- versus long-duration antibiotic treatment in elderly women (> 65 years old) who had uncomplicated UTI.9 The review identified 15 RCTs including a total of 1644 participants (see Table 2). Five RCTs compared single-dose versus short-course (3–6 days) antibiotic treatment. Persistent UTI was less common in the short-course group up to 2 weeks after treatment (n = 356, RR 2.01, 95% CI, 1.05–3.54, P = .034). This advantage was not sustained in the
Prevention of urinary tract infections in children
Although some RCTs in the review of cranberry products included children together with adults, there was no separate analysis of data for children.1
One meta-analysis investigated antibiotic prophylaxis in children and included six RCTs with a total of 388 participants, predominantly girls younger than 14 years of age, who were identified as being at risk of recurrent UTI but without a predisposing anatomic or neurologic abnormality (Table 3).10 RCTs investigated a range of antibiotic classes,
Treatment of urinary tract infections in children
The authors identified four systematic reviews that investigated antibiotic class, duration of therapy, and route of antibiotic administration in the treatment of UTI in children (see Table 3).11, 12, 13, 14
One systematic review included a meta-analysis of six RCTs enrolling 523 children aged 2 weeks to 16 years who had a diagnosis of microbiologically proven UTI and clinical acute pyelonephritis.11 These RCTs made head-to-head comparisons of different classes of antibiotics. Reported outcomes
Prevention of Urinary Tract Infections
For women who have recurrent UTIs, daily intake of cranberry juice or capsules can reduce the incidence of symptomatic UTI compared with no use of cranberry product, based on consistent, direct, precise, high-quality evidence. Based on the one RCT in the meta-analysis that included only elderly patients, there is some evidence that cranberry products may be beneficial for the prevention of UTI in people over age 60 years. No meta-analysis exists to support the use of cranberry product in the
Future directions in research
Although the authors were able to summarize meta-analyses in the prophylaxis and treatment of UTI in several populations, it is evident that there are evidence gaps for particular subgroups of people. Cranberry products remain untested in pregnant women, the elderly, and among children, and the optimum daily dose of cranberry product for preventing UTI in women has not been established. In general, when considering prophylactic measures, longer-term outcomes would increase knowledge of
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Frequent Urinary Tract Infection
2018, Physician Assistant ClinicsCitation Excerpt :In patients who cannot pinpoint an infection relationship with intercourse, antibiotic prophylaxis regimens of 6 to 12 months’ duration versus placebo have shown a significantly reduced risk of clinical recurrence of 85%. However, after antibiotic prophylaxis has ceased, there is no significantly reduced infection rate in the prophylaxis-treated individuals.33 Regardless, for many individuals, this infection-free time is life-changing.
Update on the approach of urinary tract infection in childhood
2015, Jornal de PediatriaCitation Excerpt :Therefore, as a result of the high incidence of urosepsis and severe pyelonephritis in newborns and infants <3 months of age, parenteral antibiotic therapy is always recommended. Otherwise, when choosing between oral and parenteral therapy, some factors should be considered: patient age, severity of illness, refusal of oral intake, vomiting, noncompliance with oral medication, and potential complicated febrile UTI (for instance, severe urinary tract dilatation).7,11,37,51 A multicenter randomized controlled trial by Montini et al.52 demonstrated that oral therapy was as effective as intravenous therapy followed by oral therapy for managing the first UTI episode.
Urinary tract infection; what the pediatrician should know
2011, Revista Medica Clinica Las CondesUrinary tract infection in pediatrics: an overview
2020, Jornal de PediatriaCitation Excerpt :Three RCTs compared third generation cephalosporins with other antibiotics, including amoxicillin-clavulanate and TMP-SMX. There was no difference in the reduction of persistent bacteriuria at 48 h (two RCTs, RR 5.5, 95% CI, 0.30–1.28), recurrent or persistent UTI five to ten days after the end of therapy (three RCTs, RR 0.42, 95% CI, 0.03–6.23), or the incidence of gastrointestinal adverse effects (three RCTs, n 5 108, RR 0.55, 95% CI, 0.10–3.16).110,117 Alternative options for outpatient management include outpatient parenteral therapy for patients with acute pyelonephritis.
Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children
2022, Frontiers in Pharmacology