College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
World J Urol. 2024 Apr 8;42(1):221. doi: 10.1007/s00345-024-04922-5.
Fosfomycin has been used more frequently in managing uncomplicated urinary tract infections (UTIs) due to decreased compliance and increased multidrug-resistant bacteria. The aim of this network meta-analysis was to assess the efficacy of Fosfomycin compared to Nitrofurantoin, Trimethoprim-Sulfamethoxazole (TMP-SMX), and Ciprofloxacin in terms of clinical and microbiological cure alongside with other measurements.
We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). We included randomized control trials (RCTs) with uncomplicated UTI patients who received Fosfomycin, Nitrofurantoin, TMP-SMX, or Ciprofloxacin and reported the clinical or microbiological cure. We used Cochrane Risk of Bias Assessment Tool to assess the included studies' quality. R-software was used for all statistical analysis. We ranked all antibiotics using the netrank function which yielded P scores. Frequentist network meta-analysis was used to assess the efficacy of all outcomes.
We included 13 RCTs with a total number of 3856 patients that showed Fosfomycin ranked the highest among the other antibiotics with respect to clinical cure (P-score = 0.99) and microbiological cure (P-score = 0.99) while Ciprofloxacin ranked the lowest (P-score = 0.11 and 0.02, respectively). Moreover, Ciprofloxacin yielded the highest relapse rate (P-score = 1), whereas TMP-SMX had the lowest relapse rate (P-score = 0.07). As for the adverse events, Ciprofloxacin demonstrated the highest adverse events as opposed to Fosfomycin (P-score = 0.98 and 0.05, respectively).
The network meta-analysis demonstrated that Fosfomycin is the most effective antibiotic in treating uncomplicated UTIs with respect to clinical cure, microbiological cure, and adverse events profile.
由于顺应性降低和多药耐药菌增加，磷霉素在治疗单纯性尿路感染（UTI）中的应用越来越频繁。本网络荟萃分析的目的是评估磷霉素与呋喃妥因、复方磺胺甲噁唑（TMP-SMX）和环丙沙星在临床和微生物学治愈率方面的疗效，并结合其他指标进行评估。
我们检索了 MEDLINE、Embase 和 Cochrane 对照试验中心注册库（CENTRAL）。我们纳入了接受磷霉素、呋喃妥因、TMP-SMX 或环丙沙星治疗且报告临床或微生物学治愈率的单纯性 UTI 患者的随机对照试验（RCT）。我们使用 Cochrane 偏倚风险评估工具评估纳入研究的质量。R 软件用于所有统计分析。我们使用 netrank 函数对所有抗生素进行排名，得到 P 分数。我们使用频率网络荟萃分析评估所有结局的疗效。
我们纳入了 13 项 RCT，共 3856 名患者，结果显示磷霉素在临床治愈率（P 分数=0.99）和微生物学治愈率（P 分数=0.99）方面优于其他抗生素，而环丙沙星排名最低（P 分数分别为 0.11 和 0.02）。此外，环丙沙星的复发率最高（P 分数=1），而 TMP-SMX 的复发率最低（P 分数=0.07）。至于不良反应，环丙沙星的不良反应发生率最高，而磷霉素的不良反应发生率最低（P 分数分别为 0.98 和 0.05）。
网络荟萃分析表明，磷霉素是治疗单纯性尿路感染最有效的抗生素，在临床治愈率、微生物学治愈率和不良反应方面均有优势。
