非甾体抗炎治疗在单纯性尿路感染中是否不劣于抗生素治疗：一项系统评价
Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review.
作者信息
Carey Matthew R, Vaughn Valerie M, Mann Jason, Townsend Whitney, Chopra Vineet, Patel Payal K
机构信息
University of Michigan Medical School, Ann Arbor, MI, USA.
Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
出版信息
J Gen Intern Med. 2020 Jun;35(6):1821-1829. doi: 10.1007/s11606-020-05745-x. Epub 2020 Apr 8.
BACKGROUND
Amid growing antimicrobial resistance, there is an increasing focus on antibiotic stewardship efforts to reduce inappropriate antibiotic prescribing. In this context, novel approaches for treating infections without antibiotics are being explored. One such strategy is the use of non-steroidal anti-inflammatory drugs (NSAIDs) for uncomplicated urinary tract infections (UTIs). Therefore, we conducted a systematic review of randomized controlled trials to evaluate the rates of symptom resolution and infectious complications in adult women with uncomplicated UTIs treated with antibiotics versus NSAIDs.
METHODS
We systematically searched PubMed, CINHAL, Scopus, Web of Science Core Collection, EMBASE, and ClinicalTrials.gov from inception until January 13, 2020, for randomized controlled trials comparing NSAIDs with antibiotics for treatment of uncomplicated UTIs in adult women. Studies comparing symptom resolution between groups were eligible. Two authors screened all studies independently and in duplicate; data were abstracted using a standardized template. Risk of bias was assessed using the Cochrane Collaboration tool.
RESULTS
Five randomized trials that included 1309 women with uncomplicated UTI met inclusion criteria. Three studies (1130 patients) favored antibiotic therapy in terms of symptom resolution. Two studies (179 patients) found no difference between NSAIDs and antibiotics in terms of symptom resolution. Three studies reported rates of pyelonephritis, two of which found higher rates in patients treated with NSAIDs versus antibiotics. Between two studies that reported this outcome (747 patients), patients randomized to NSAIDs received fewer antibiotic prescriptions compared with those in the antibiotics group. Three studies were at low risk of bias, one had an unclear risk of bias, and one was at high risk of bias.
DISCUSSION
For the outcomes of symptom resolution and complications in adult women with UTI, evidence favors antibiotics over NSAIDs.
PROSPERO
CRD42018114133.
背景
在抗菌药物耐药性不断增加的背景下，人们越来越关注抗生素管理措施，以减少不适当的抗生素处方。在此背景下，正在探索不使用抗生素治疗感染的新方法。一种这样的策略是使用非甾体抗炎药（NSAIDs）治疗单纯性尿路感染（UTIs）。因此，我们进行了一项随机对照试验的系统评价，以评估用抗生素与NSAIDs治疗的成年单纯性UTIs女性患者的症状缓解率和感染并发症发生率。
方法
我们从数据库建立至2020年1月13日，系统检索了PubMed、CINHAL、Scopus、Web of Science核心合集、EMBASE和ClinicalTrials.gov，以查找比较NSAIDs与抗生素治疗成年女性单纯性UTIs的随机对照试验。比较组间症状缓解情况的研究符合纳入标准。两名作者独立且重复地筛选所有研究；使用标准化模板提取数据。使用Cochrane协作工具评估偏倚风险。
结果
五项纳入1309例单纯性UTI女性患者的随机试验符合纳入标准。三项研究（1130例患者）在症状缓解方面支持抗生素治疗。两项研究（179例患者）发现NSAIDs与抗生素在症状缓解方面无差异。三项研究报告了肾盂肾炎发生率，其中两项发现NSAIDs治疗患者的发生率高于抗生素治疗患者。在两项报告此结果的研究（747例患者）中，随机分配至NSAIDs组的患者与抗生素组相比，接受的抗生素处方较少。三项研究偏倚风险较低，一项偏倚风险不明确，一项偏倚风险较高。
讨论
对于成年UTI女性患者的症状缓解和并发症结局，证据支持使用抗生素而非NSAIDs。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42018114133。
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