Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: A meta-analysis of randomized controlled trials - 07/08/11

Doi : 10.1016/j.jinf.2008.12.009

Matthew E. Falagas ^a,^b,^c,^⁎ , Ioannis K. Kotsantis ^a, Evridiki K. Vouloumanou ^a, Petros I. Rafailidis ^a,^b
^a Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
^b Department of Medicine, Henry Dunant Hospital, Athens, Greece
^c Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

Correspondence to: Matthew E. Falagas, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Greece. Tel.: +30 694 61 10 000; fax: +30 210 68 39 605.

Summary

Background

Acute uncomplicated cystitis is one of the most common bacterial infections in women and is conventionally treated with antibiotics. However, emergence of resistant uropathogens forces physicians to reconsider the prescription of antibiotics for acute uncomplicated cystitis in non-pregnant young women.

Objective

To evaluate the effectiveness of antibiotics in the treatment of acute uncomplicated cystitis.

Methods

We searched PubMed, the Cochrane Central Register of Controlled Trials and Scopus database.

Results

Five randomized controlled trials (RCTs) involving non-pregnant, non-immunocompromised adult women with clinically and microbiologically documented acute uncomplicated cystitis were included. Clinical success was significantly more likely in women treated with antibiotics versus those treated with placebo [4 RCTs, 1062 patients, random effects model (REM), odds ratio (OR)=4.81, 95% confidence intervals (CI)=2.51–9.21]. Antibiotics were also superior to placebo, regarding cure (4 RCTs, 1062 patients, REM, OR=4.67, 95%CI=2.34–9.35); microbiological eradication at the end of treatment (3 RCTs, 967 patients, REM, OR=10.67, 95%CI=2.96–38.43); after the end of treatment (3 RCTs, 738 patients, REM, OR=5.38, 95%CI=1.63–17.77), and microbiological reinfection or relapse (5 RCTs, 843 patients, REM, OR=0.27, 95%CI=0.13–0.55). However, adverse events were more likely to occur in antibiotic-treated patients versus placebo-treated women (4 RCTs, 1068 patients, REM, OR=1.64, 95%CI=1.10–2.44). No difference was found between the compared treatment arms regarding study withdrawals from adverse events, the development of pyelonephritis and emergence of resistance.

Conclusion

Antibiotics are superior to placebo regarding both clinical and microbiological success in adult non-pregnant women with microbiologically confirmed acute uncomplicated cystitis. However, they are associated with more adverse events.

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Keywords : Escherichia coli, Lower urinary tract infections, Antibiotic resistance, Bacteriuria, Fluoroquinolones