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Efficacy and safety of quinolones vs. other antimicrobials for the treatment of uncomplicated urinary tract infections in adults: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

In the present study, we aimed to compare the efficacy and safety of quinolones with trimethoprim-sulfamethoxazole (TMP/SMX), nitrofurantoin, fosfomycin, and β-lactams for the treatment of uncomplicated urinary tract infections (UTIs) in adults.

Methods

All controlled clinical trials assessing quinolones for uncomplicated UTIs in adults were searched from PubMed, Embase, and Cochrane Library databases. Meta-analyses were used to evaluate the efficacy and safety in randomized controlled trials (RCTs).

Results

A total of 47 RCTs consisting of 8992 patients were included in the present analysis. The clinical and bacteriological remission rates of quinolones were significantly higher (P < 0.01) compared with β-lactams and nitrofurantoin, while quinolones showed similar clinical and bacteriological remission rates compared with TMP/SMX and fosfomycin. Moreover, the bacterial resistance and relapse rates of quinolones were significantly lower (P < 0.01) compared with TMP/SMX, β-lactams, and nitrofurantoin. Regarding the adverse drug reactions (ADRs), quinolones did not bring higher risks, while the incidence of ADRs in the quinolone group was also even significantly lower (P < 0.01) compared with the TMP/SMX and nitrofurantoin groups, including the most reported ADRs associated with the gastrointestinal tract.

Conclusions

Compared with other anti-UTI drugs, quinolones exerted an excellent effect on clinical remission and bacteriological eradication, and the application of quinolones did not bring a higher risk of ADRs.

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Funding

This work was supported by the National Natural Science Foundations of China (81770004 and 82073894) and Cultivation Project of PLA General Hospital for Distinguished Young Scientists (2020-JQPY-004).

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Author notes

  1. Kaicheng Yan and Man Zhu contributed equally to this work.

Authors and Affiliations

  1. Medical School of Chinese PLA, Beijing, 100853, China

    Kaicheng Yan

  2. Department of Pharmacy, Medical Supplies Center of Chinese PLA General Hospital, 28 Fu Xing Road, Beijing, 100853, People’s Republic of China

    Kaicheng Yan, Man Zhu, Yuting Jia, Jin Wang & Yun Cai

Authors
  1. Kaicheng Yan
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  2. Man Zhu
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  3. Yuting Jia
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  4. Jin Wang
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Contributions

Kaicheng Yan and Man Zhu reviewed the literature, extracted and analyzed the data, and drafted the manuscript; Yuting Jia and Jin Wang extracted and analyzed the data; as a corresponding author, Yun Cai contributed in study design, protocol, data extraction, data analysis, and writing.

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Correspondence to Yun Cai.

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Yan, K., Zhu, M., Jia, Y. et al. Efficacy and safety of quinolones vs. other antimicrobials for the treatment of uncomplicated urinary tract infections in adults: a systematic review and meta-analysis. Int Urogynecol J 33, 1103–1123 (2022). https://doi.org/10.1007/s00192-021-05013-4

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  • DOI: https://doi.org/10.1007/s00192-021-05013-4

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