Novel β-lactam/β-lactamase inhibitors versus alternative antibiotics for the treatment of complicated intra-abdominal infection and complicated urinary tract infection: a meta-analysis of randomized controlled trials

Abstract Background: Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates still rise. Objectives: This meta-analysis aims to determine whether NSAIDs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics. Data Sources: PUBMED,MEDLINE,EMBASE,CENTRAL,ACP databases and other grey literature sources from inception to June 2019 were sought in the relevant search. Study Eligibility Criteria, Participants and Intervention: Randomized controlled trials that compare the use of NSAIDs versus antibiotics in non-pregnant women ≥ 18 years old with uncomplicated urinary tract infection. Methods: Primary outcomes were symptom resolution of UTI at Day 3 or 4 of intervention,and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis with substantial heterogeneity. Results: The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment(RR: 0.69; 95% CIs [0.55, 0.86], I 2 =73).The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], I 2 =0%).Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77; 95% CIs [1.95, 3.94], I 2 =36%).Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.10; 95% Cis [2.17, 4.43], I 2 =53%). Conclusion: This meta-analysis could not prove non-inferiority of NSAIDs over antibiotics. However,the authors would still recommend maintaining the use of empiric antibiotic therapy as the primary treatment for UTI because of limited NSAID benefits with complication risks.

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Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials

10.21203/rs.2.20800/v1 ◽

2020 ◽

Author(s):

Albert Macaire Chua Ong Lopez ◽

Charles Jeffrey L. Tan ◽

Antonio S. Yabon II ◽

Armin N. Masbang

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Randomized Controlled Trials ◽

Pregnant Women ◽

Urine Culture ◽

Meta Analysis ◽

Controlled Trials ◽

Symptom Resolution ◽

Randomized Controlled

Abstract Background: Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates still rise. Objectives: This meta-analysis aims to determine whether NSAIDs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics. Data Sources: PUBMED,MEDLINE,EMBASE,CENTRAL,ACP databases and other grey literature sources from inception to June 2019 were sought in the relevant search. Study Eligibility Criteria, Participants and Intervention: Randomized controlled trials that compare the use of NSAIDs versus antibiotics in non-pregnant women ≥ 18 years old with uncomplicated urinary tract infection. Methods: Primary outcomes were symptom resolution of UTI at Day 3 or 4 of intervention,and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis with substantial heterogeneity. Results: The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment(RR: 0.69; 95% CIs [0.55, 0.86], I 2 =73).The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], I 2 =0%).Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77; 95% CIs [1.95, 3.94], I 2 =36%).Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.10; 95% Cis [2.17, 4.43], I 2 =53%). Conclusion: This meta-analysis could not prove non-inferiority of NSAIDs over antibiotics. However,the authors would still recommend maintaining the use of empiric antibiotic therapy as the primary treatment for UTI because of limited NSAID benefits with complication risks.

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