Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China; Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.
Int J Antimicrob Agents. 2020 Jul;56(1):106018. doi: 10.1016/j.ijantimicag.2020.106018. Epub 2020 May 15.
This systematic review and meta-analysis investigated the efficacy and safety of single-dose fosfomycin tromethamine (FT) versus other antibiotic agents in women suffering from lower uncomplicated urinary tract infection (uUTI) and pregnant women with uUTI or asymptomatic bacteriuria (ASB).
MEDLINE, EMBASE and the Cochrane library were searched to identify relevant literature. Twenty-one studies were identified. Nine of the 21 studies enrolled 21 22 patients and were used to compare the clinical resolution of uUTI between non-pregnant and pregnant women. Given that uUTI and ASB are assessed using similar microbiological evaluation methods, all 3103 patients in the identified 21 studies were pooled to determine microbiological resolution between uUTI or ASB patients. Safety outcomes of the treatments were analysed in 15 studies.
The results showed that single-dose FT was comparable with other antibiotic agents in clinical resolution of uUTI (OR 0.89; 95% CI 0.71-1.10; P = 0.41) in non-pregnant (P = 0.32) and pregnant women (P = 0.64). Moreover, single-dose FT was equal to other antibiotics in microbiological resolution, and there was no difference in overall microbiological resolution (OR 1.11; 95% CI 0.92-1.34; P = 0.29) among non-pregnant women with uUTI (P = 0.48), pregnant women with uUTI (P = 0.81) and pregnant women with ASB (P = 0.30). There were no serious fosfomycin-related adverse events and most frequent adverse events were mainly gastrointestinal.
This meta-analysis suggests that single-dose fosfomycin tromethamine produces equivalent clinical outcomes to comparator antibiotics in terms of clinical efficacy and microbiological efficacy. It is therefore clinically effective and safe for women with uUTI and pregnant women with uUTI or ASB, and has higher patient compliance.
本系统评价和荟萃分析研究了单剂量磷霉素氨丁三醇（FT）与其他抗生素在患有下尿路感染（uUTI）的女性和患有 uUTI 或无症状菌尿（ASB）的孕妇中的疗效和安全性。
检索 MEDLINE、EMBASE 和 Cochrane 图书馆以确定相关文献。确定了 21 项研究。21 项研究中的 9 项纳入了 2122 名患者，用于比较非孕妇和孕妇 uUTI 的临床缓解情况。鉴于 uUTI 和 ASB 采用类似的微生物评估方法进行评估，因此将确定的 21 项研究中的所有 3103 名患者汇总，以确定 uUTI 或 ASB 患者之间的微生物学缓解情况。在 15 项研究中分析了治疗的安全性结果。
结果表明，在非孕妇（P=0.32）和孕妇（P=0.64）中，单剂量 FT 在 uUTI 的临床缓解方面与其他抗生素相当（OR 0.89；95%CI 0.71-1.10；P=0.41）。此外，单剂量 FT 在微生物学缓解方面与其他抗生素相当，非孕妇 uUTI（OR 1.11；95%CI 0.92-1.34；P=0.29）、孕妇 uUTI（P=0.48）和孕妇 ASB（P=0.30）之间的整体微生物学缓解率无差异。没有严重的磷霉素相关不良事件，最常见的不良事件主要是胃肠道。
本荟萃分析表明，单剂量磷霉素氨丁三醇在临床疗效和微生物疗效方面与对照抗生素产生等效的临床结果。因此，对于患有 uUTI 的女性和患有 uUTI 或 ASB 的孕妇，它具有临床疗效和安全性，并且具有更高的患者依从性。
