Alanazi Menyfah Q
Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Ther Clin Risk Manag. 2021 Nov 21;17:1209-1217. doi: 10.2147/TCRM.S334886. eCollection 2021.
Uncomplicated urinary tract infections (uUTIs) are one of the main reasons for emergency department (ED) visits. Many antibiotics can be used for uUTI treatment. Currently, no data concerning uUTIs and cost-effectiveness have been reported in Saudi Arabia. This study aimed to investigate antibiotic and cost-effectiveness of beta-lactams, fluoroquinolones, and nitrofurantoin as first-line uUTI treatment.
This study was a retrospective cohort based on a five-arm comparative outcome analysis. A cost-effectiveness analysis and comparative group of uUTI treatments in the ED at King Abdulaziz Medical City (KAMC) in Saudi Arabia over a three-month follow-up period was done. The patient group consisted of those presenting to the ED with uUTIs who were treated initially with one of five antibiotics: (1) amoxicillin/clavulanic acid, (2) cefuroxime, (3) ciprofloxacin, (4) nitrofurantoin, or (5) norfloxacin. The main outcomes were effectiveness in terms of cure rates, symptom-free days (SFDs), and estimations of cost-effectiveness among this group.
A total of 865 adult patients who presented with uUTIs were enrolled. Most patients (89.5%) completely recovered, whereas 10.5% of patients were readmitted to the ED with recurrent infections. Effectiveness in terms of the highest cure rate was observed with nitrofurantoin and amoxicillin/clavulanic acid (93.2% and 92.2%, respectively) followed by norfloxacin, cefuroxime, and ciprofloxacin; no significant differences in cure rates were found among these antibiotics. Antibiotic effectiveness in terms of SFDs showed that nitrofurantoin produced the longest SFD period (76 days) followed by amoxicillin/clavulanic acid (69 days). A cost-effectiveness analysis in terms of uUTI cure rates and number of SFDs indicated that nitrofurantoin presented the highest cost-effectiveness followed by amoxicillin/clavulanic acid, norfloxacin, ciprofloxacin, and cefuroxime.
A comparison of five antibiotics for uUTI treatment did not yield clinically significant differences in cure rates. Nitrofurantoin was more cost-effective than the other antibiotics.
单纯性尿路感染（uUTIs）是急诊科就诊的主要原因之一。许多抗生素可用于治疗uUTIs。目前，沙特阿拉伯尚未有关于uUTIs及其成本效益的数据报道。本研究旨在调查β-内酰胺类、氟喹诺酮类和呋喃妥因作为一线uUTI治疗药物的抗菌效果及成本效益。
本研究是一项基于五组比较结果分析的回顾性队列研究。对沙特阿拉伯阿卜杜勒阿齐兹国王医疗城（KAMC）急诊科uUTI治疗进行了为期三个月的随访期成本效益分析和比较组研究。患者组包括那些因uUTIs到急诊科就诊并最初接受以下五种抗生素之一治疗的患者：（1）阿莫西林/克拉维酸，（2）头孢呋辛，（3）环丙沙星，（4）呋喃妥因，或（5）诺氟沙星。主要结局包括治愈率、无症状天数（SFDs）方面的有效性以及该组患者的成本效益评估。
共纳入865例出现uUTIs的成年患者。大多数患者（89.5%）完全康复，而10.5%的患者因反复感染再次入住急诊科。呋喃妥因和阿莫西林/克拉维酸的治愈率最高（分别为93.2%和92.2%），其次是诺氟沙星、头孢呋辛和环丙沙星；这些抗生素之间的治愈率无显著差异。就SFDs而言，抗生素有效性表明呋喃妥因产生的SFD期最长（76天），其次是阿莫西林/克拉维酸（69天）。根据uUTI治愈率和SFDs数量进行的成本效益分析表明，呋喃妥因的成本效益最高，其次是阿莫西林/克拉维酸、诺氟沙星、环丙沙星和头孢呋辛。
对五种用于uUTI治疗的抗生素进行比较，治愈率在临床上无显著差异。呋喃妥因比其他抗生素更具成本效益。
