Document Detail

Modes of administration of antibiotics for symptomatic severe urinary tract infections.
MedLine Citation:
PMID:  17943784     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Urinary tract infection (UTI), worldwide, is a major source of disease in children and adults. As it may have long-term consequences such as kidney failure and hypertension, it is important to treat patients with UTI adequately. Although standard management of severe UTI usually means intravenous (IV) therapy, at least initially, there are studies showing that oral therapy may also be effective.
OBJECTIVES: To assess whether the mode of administration of antibiotic therapy for severe UTI has an effect on cure rate, reinfection rate and kidney scarring.
SEARCH STRATEGY: The Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE and EMBASE were searched. No language restriction was applied. Reference lists of relevant articles and reviews were checked for additional studies and authors of relevant articles/abstracts were contacted for further information. Date of last search: July 2007.
SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing different modes of antibiotic application for patients with severe UTI (children and adults) were considered.
DATA COLLECTION AND ANALYSIS: Study quality was assessed and data extracted. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or mean difference (WMD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS: Fifteen RCTs (1743 patients) were included. Studies compared oral versus parenteral treatment (1), oral versus switch treatment (initial intravenous (IV) or intramuscular (IM) therapy followed by oral therapy) (5), switch versus parenteral treatment (6) and single dose parenteral followed by oral therapy versus oral (1) or switch therapy (3). There was a variety of short-term and long-term outcomes, but no pooled outcomes showed significant differences. Most included studies were small though and there were few outcomes for combination in a meta-analysis.
AUTHORS' CONCLUSIONS: There is no evidence suggesting that oral antibiotic therapy is less effective for treatment of severe UTI than parenteral or initial parenteral therapy. The results of this review suggest that the mode of application does not determine therapeutic success.
A Pohl
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2007-10-17
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2007  
Date Detail:
Created Date:  2007-10-18     Completed Date:  2008-01-17     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD003237     Citation Subset:  IM    
University Clinic Freiburg, Center of Clincial Studies, Elsässerstr. 2, Freiburg, Germany, 79110.
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MeSH Terms
Administration, Oral
Anti-Bacterial Agents / administration & dosage*
Anti-Infective Agents, Urinary / administration & dosage*
Randomized Controlled Trials as Topic
Urinary Tract Infections / drug therapy*
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anti-Infective Agents, Urinary

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