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Efficacy and safety of quinolones for the treatment of uncomplicated urinary tract infections in women: a network meta-analysis

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Abstract

Introduction and hypothesis

Uncomplicated urinary tract infection (uUTI) is defined as the presence of pathogenic organisms in the urinary tract without anatomical and functional abnormalities, is accompanied by inflammatory leukocytes and cytokines and may or may not develop clinical symptoms. The frequency of uncomplicated urinary tract infection is higher in young women. Several quinolone treatment regimens are available; however, since we do not know which is the best antibiotic regimen for the treatment of this urinary infection, we analyzed the published evidence and conducted a systematic review with network meta-analysis. The aim was to compare and hierarchize quinolones according to their efficacy and safety and to identify the best treatment for uncomplicated urinary tract infection in women through a systematic review with network meta-analysis.

Methods

Medline, Embase, LILACS, Cochrane CENTRAL and other databases were searched for trials. Bias in the trials was assessed using the Cochrane Collaboration tool. To analyze efficacy and adverse events, for direct comparisons, we obtained risk ratios and 95% confidence intervals by applying a fixed-effects model using tau2 and Q2 tests to calculate the heterogeneity. For the network meta-analysis, we analyzed the indirect comparisons by Bucher’s method.

Results

We included 18 trials (8765 women). For premenopausal women, ofloxacin had a 57% probability of achieving remission but an 83% frequency of adverse events. For postmenopausal women, ofloxacin was 82% more effective for remission, with a 49% frequency of adverse events, compared with other types of quinolones.

Conclusions

Compared with other quinolones, ofloxacin 200 mg once daily for a treatment duration < 3 days provides the highest clinical and bacteriological remission rates with the lowest relapse and resistance rates for the treatment of women with uUTIs. However, additional trials are needed to confirm our findings, especially when the treatment duration exceeds 3 days.

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Abbreviations

CI 95%:

95% confidence intervals

DNA:

deoxyribonucleic acid

IF:

inconsistency factor

MeSH:

Medical Subject Headings

NMA:

network meta-analysis

RR:

risk ratio

SUCRA:

surface under the cumulative ranking curve

TMP/SMX:

trimethoprim-sulfamethoxazole

UTI:

urinary tract infection

uUTI:

uncomplicated urinary tract infection

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Acknowledgments

We thank Deborah H. S. for English language editing.

Funding

Senosiain Laboratories S.A. provided only financial support for the acquisition of articles but was not involved in the research, the collection, analysis or interpretation of data or in the writing of the manuscript. The authors declare that they have no conflict of interest or disclosures and received no compensation from Senosiain Laboratories S.A. for their work in the writing of this manuscript.

This manuscript is derived from the project registered with the number 2019/018 approved by the Research Committee of Instituto Nacional de Pediatría.

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Authors and Affiliations

  1. Methodology Research Unit, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Col. Insurgentes Cuicuilco, Coyoacán, zip 04530, Mexico City, Mexico

    Alejandro González-Garay

  2. Medical Research Unit, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Col. Insurgentes Cuicuilco, Coyoacán, zip 04530, Mexico City, Mexico

    Liliana Velasco-Hidalgo & Roberto Rivera-Luna

  3. Hospital Epidemiology Department, Instituto Nacional en Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vaco de Quiroga No. 15, Col. Belisario Domínguez Sección XVI, Tlalpan, zip 14080, Mexico City, Mexico

    Eric Ochoa-Hein

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  1. Alejandro González-Garay
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Contributions

A González-Garay contributed to the conceptualization, writing draft and review, methodology, resources, formal analysis, investigation and supervision of this work.

L Velasco-Hidalgo contributed to the conceptualization, writing draft, methodology, formal analysis, investigation and supervision of this work.

E Ochoa-Hein contributed to the conceptualization, validation, investigation, editing, visualization, supervision, writing review and editing of this manuscript.

R Rivera-Luna contributed to the conceptualization, methodology, resources, validation, visualization, writing review and editing of this manuscript.

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Correspondence to Alejandro González-Garay.

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González-Garay, A., Velasco-Hidalgo, L., Ochoa-Hein, E. et al. Efficacy and safety of quinolones for the treatment of uncomplicated urinary tract infections in women: a network meta-analysis. Int Urogynecol J 32, 3–15 (2021). https://doi.org/10.1007/s00192-020-04255-y

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