A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis
- PMID:30191339
- DOI: 10.1007/s10096-018-3371-y
A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis
Abstract
There is increasing resistance to the oral antibiotics currently recommended for the treatment of pyelonephritis, and increased healthcare costs are associated with the reliance on alternative intravenous agents. We, therefore, performed a systematic review of randomised controlled trials to determine the clinical efficacy and safety of oral antibiotics for the treatment of pyelonephritis in adults. A search of four major medical databases (MEDLINE, Embase+ Embase classic, CENTRAL and Cochrane Database for Systematic Reviews) in addition to manual reference searching of relevant reviews was conducted. Clinical cure and adverse event rates were reported, and trial quality and bias were assessed. A total of 277 studies were reviewed; five studies matched all eligibility criteria and were included. Antibiotics included were cefaclor, ciprofloxacin, gatifloxacin, levofloxacin, lomefloxacin, loracarbef, norfloxacin, rufloxacin and trimethoprim-sulfamethoxazole. In included studies, the clinical success of the outpatient treatment of pyelonephritis by cefaclor, ciprofloxacin and norfloxacin at 4 to 6 weeks was comparable at between 83 to 95%. Relatively high rates of adverse events were noted in a trial of ciprofloxacin (24%) and trimethoprim-sulfamethoxazole (33%). Significant heterogeneity between all aspects of the trial designs was identified, with all studies having a potential for bias. This review demonstrates a need for high-quality clinical trials into the oral antibiotic treatment of pyelonephritis, with more consistent designs and reporting of outcomes. There are data to support further research into oral norfloxacin and cefaclor for the outpatient treatment of pyelonephritis in adults.
Keywords: Antibiotic; Oral; Pyelonephritis; Resistance; Urinary tract infection.
Similar articles
- Loracarbef (LY163892) versus cefaclor and norfloxacin in the treatment of uncomplicated pyelonephritis.Hyslop DL, Bischoff W.Hyslop DL, et al.Am J Med. 1992 Jun 22;92(6A):86S-94S. doi: 10.1016/0002-9343(92)90614-h.Am J Med. 1992.PMID:1621752Clinical Trial.
- Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, Reuning-Scherer J, Church DA.Talan DA, et al.JAMA. 2000 Mar 22-29;283(12):1583-90. doi: 10.1001/jama.283.12.1583.JAMA. 2000.PMID:10735395Clinical Trial.
- [Current role of aminoglycosides in the treatment of acute pyelonephritis].Caron F.Caron F.Prog Urol. 1998 Dec;8(6):1077-9.Prog Urol. 1998.PMID:9894273Review.French.
- Pyelonephritis treatment in the community emergency department: Cephalosporins vs. first-line agents.Vogler S, Pavich E.Vogler S, et al.Am J Emerg Med. 2018 Nov;36(11):2054-2057. doi: 10.1016/j.ajem.2018.08.016. Epub 2018 Aug 8.Am J Emerg Med. 2018.PMID:30119986
- Antibiotics for acute pyelonephritis in children.Hodson EM, Willis NS, Craig JC.Hodson EM, et al.Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003772. doi: 10.1002/14651858.CD003772.pub3.Cochrane Database Syst Rev. 2007.Update in:Cochrane Database Syst Rev. 2014 Jul 28;(7):CD003772. doi: 10.1002/14651858.CD003772.pub4.PMID:17943796Updated.Review.
Cited by
- Variability in Profiles and Prevalences of Gram-Negative Bacteria in Urinary Tract Infections: A Population-Based Analysis.Nedbal C, Mahobia N, Browning D, Somani BK.Nedbal C, et al.J Clin Med. 2024 Sep 7;13(17):5311. doi: 10.3390/jcm13175311.J Clin Med. 2024.PMID:39274523Free PMC article.
- Consultations and antibiotic treatment for urinary tract infections in Norwegian primary care 2006-2015, a registry-based study.Haugom LEA, Ruths S, Emberland KE, Eliassen KER, Rortveit G, Wensaas KA.Haugom LEA, et al.BMC Fam Pract. 2021 Jun 24;22(1):127. doi: 10.1186/s12875-021-01470-4.BMC Fam Pract. 2021.PMID:34167484Free PMC article.
- Treatment of uncomplicated UTI in males: a systematic review of the literature.Farrell K, Tandan M, Hernandez Santiago V, Gagyor I, Braend AM, Skow M, Vik I, Jansaaker F, Hayward G, Vellinga A.Farrell K, et al.BJGP Open. 2021 Apr 26;5(2):bjgpopen20X101140. doi: 10.3399/bjgpopen20X101140. Print 2021 Apr.BJGP Open. 2021.PMID:33234514Free PMC article.
- A pharmacokinetic-pharmacodynamic assessment of oral antibiotics for pyelonephritis.Cattrall JWS, Asín-Prieto E, Freeman J, Trocóniz IF, Kirby A.Cattrall JWS, et al.Eur J Clin Microbiol Infect Dis. 2019 Dec;38(12):2311-2321. doi: 10.1007/s10096-019-03679-9. Epub 2019 Sep 7.Eur J Clin Microbiol Infect Dis. 2019.PMID:31494827Free PMC article.
- Gram negative bacteria related urinary tract infections: spectrum of antimicrobial resistance over 9 years in a University tertiary referral Hospital.Carlotta N, Nitin M, Dave B, Bhaskar Kumar S.Carlotta N, et al.Ther Adv Infect Dis. 2024 Feb 2;11:20499361241228342. doi: 10.1177/20499361241228342. eCollection 2024 Jan-Dec.Ther Adv Infect Dis. 2024.PMID:38312849Free PMC article.
References
Publication types
MeSH terms
Substances
Related information
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical