Hashmi Muhammad Usman, Sufi Yasmeen, Zahoor Tamseela, Hameed Hifza, Ejaz Rimsha, Nisar Nida, Zahra Rubab, Ramzan Hussain, Kumar Kundan, Abdullah Lava
Rawalpindi Medical University, Rawalpindi, Pakistan.
Rahmah Academy of Research Excellence, Islamabad, Pakistan.
Int Urol Nephrol. 2025 Jun 19. doi: 10.1007/s11255-025-04615-x.
Urinary tract infections (UTIs) are common in young children and women and even more so in pregnant women. Ciprofloxacin has been a long-used regime to treat UTIs, although recently the paradigm has shifted towards Fosfomycin. This shift is driven by rising antibiotic resistance, safety concerns with fluoroquinolones, and the need for alternative treatments with broader efficacy and fewer adverse effects. This systematic review and meta-analysis assess the effectiveness and safety of Fosfomycin compared to Ciprofloxacin for treating urinary tract infections in adults.
A systematic search was conducted across PubMed, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus using search strings combining "Fosfomycin," "Ciprofloxacin," and "urinary tract infections." Study selection and screening were managed using Covidence, with duplicates removed. Four randomized controlled trials met the inclusion criteria following primary and secondary screening. Data analysis was performed using Review Manager (RevMan), with results presented as forest plots. A random-effects model was applied in cases of significant heterogeneity. The outcomes assessed included clinical remission, bacterial eradication, and adverse effects, based on data from three of the included studies.
Four studies matched our inclusion criteria and were processed further for analysis. For bacterial eradication, the total number of patients was 334 patients, bacterial eradication during 10 days was achieved in 143 participants in the fosfomycin group and 110 participants in the ciprofloxacin group. Bacterial eradication was significantly higher in the fosfomycin group compared to the ciprofloxacin group (OR 2.03, 95% CI 1.22-3.36, p = 0.006). For clinical remission, no significant difference was found in 3 studies in a total of 278 patients (OR 1.26, 95% CI 0.72-2.21, p = 0.42). Out of a total of 356 patients, 74 experienced adverse effects in the fosfomycin group and 46 in the ciprofloxacin group. The appearance of adverse effects was significantly higher in the fosfomycin group (OR 2.66, CI 1.53-4.62, p = 0.0005).
The results of our meta-analysis show that bacterial eradication was significantly higher in the Fosfomycin group compared to the Ciprofloxacin group. There was no difference between the two drugs in terms of clinical remission. The appearance of adverse effects was significantly higher in the Fosfomycin group. Despite a higher incidence of adverse effects, Fosfomycin demonstrated superior bacterial eradication, suggesting its potential role as an effective empirical option, particularly in regions with elevated fluoroquinolone resistance. Hence, it was deduced that Fosfomycin is more effective than Ciprofloxacin for bacterial eradication in the treatment of urinary tract infections. These findings are influenced by significant heterogeneity in study design, populations, and outcome definitions, which should be considered when interpreting the pooled estimates.
尿路感染（UTIs）在幼儿和女性中很常见，在孕妇中更为常见。环丙沙星长期以来一直用于治疗尿路感染，尽管最近治疗模式已转向磷霉素。这种转变是由抗生素耐药性上升、对氟喹诺酮类药物安全性的担忧以及对具有更广泛疗效和更少副作用的替代治疗方法的需求所驱动的。本系统评价和荟萃分析评估了磷霉素与环丙沙星相比治疗成人尿路感染的有效性和安全性。
使用结合了“磷霉素”、“环丙沙星”和“尿路感染”的检索词，在PubMed、EMBASE、Cochrane图书馆、科学网、谷歌学术和Scopus中进行系统检索。使用Covidence进行研究选择和筛选，去除重复项。经过一级和二级筛选，四项随机对照试验符合纳入标准。使用Review Manager（RevMan）进行数据分析，结果以森林图呈现。在存在显著异质性的情况下应用随机效应模型。根据纳入研究中的三项研究的数据，评估的结果包括临床缓解、细菌清除和不良反应。
四项研究符合我们的纳入标准，并进一步进行分析处理。对于细菌清除，患者总数为334例，磷霉素组143例参与者在10天内实现了细菌清除，环丙沙星组110例参与者实现了细菌清除。与环丙沙星组相比，磷霉素组的细菌清除率显著更高（OR 2.03，95%CI 1.22 - 3.36，p = 0.006）。对于临床缓解，在总共278例患者的3项研究中未发现显著差异（OR 1.26，95%CI 0.72 - 2.21，p = 0.42）。在总共356例患者中，磷霉素组74例出现不良反应，环丙沙星组46例出现不良反应。磷霉素组不良反应的出现率显著更高（OR 2.66，CI 1.53 - 4.62，p = 0.0005）。
我们的荟萃分析结果表明，与环丙沙星组相比，磷霉素组的细菌清除率显著更高。两种药物在临床缓解方面没有差异。磷霉素组不良反应的出现率显著更高。尽管不良反应发生率较高，但磷霉素显示出卓越的细菌清除效果，表明其作为一种有效的经验性选择的潜在作用，特别是在氟喹诺酮耐药性升高的地区。因此，推断在治疗尿路感染时，磷霉素在细菌清除方面比环丙沙星更有效。这些发现受到研究设计、人群和结果定义方面显著异质性的影响，在解释汇总估计值时应予以考虑。
