No evidence that oral antibiotic therapy is less effective for treating urinary tract infection than intravenous antibiotics

Pohl A

Published Online:

October 8, 2008

Severe urinary tract infection (UTI) is a common infection in adults and children, causing acute disease with a variety of symptoms such as fever and flank pain. This may lead to kidney damage, kidney failure or hypertension. Standard therapy involves antibiotics given at least initially by injection. This review identified 15 studies (1743 participants). The results of this review suggest oral therapy is equally effective in treating UTI and preventing long-term damage. This might reduce costs but also inconvenience for the patient.

Abstract (click to read)

Background:

Urinary tract infection (UTI), worldwide, is a major source of disease in children and adults. As it may have long-term consequences such as kidney failure and hypertension, it is important to treat patients with UTI adequately. Although standard management of severe UTI usually means intravenous (IV) therapy, at least initially, there are studies showing that oral therapy may also be effective.

Objectives:

To assess whether the mode of administration of antibiotic therapy for severe UTI has an effect on cure rate, reinfection rate and kidney scarring.

Search strategy:

The Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library), MEDLINE and EMBASE were searched. No language restriction was applied. Reference lists of relevant articles and reviews were checked for additional studies and authors of relevant articles/abstracts were contacted for further information.

Selection criteria:

All randomised controlled trials (RCTs) comparing different modes of antibiotic application for patients with severe UTI (children and adults) were considered.

Data collection and analysis:

Study quality was assessed and data extracted. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results:

Fifteen RCTs (1743 patients) were included. Studies compared oral versus parenteral treatment (1), oral versus switch treatment (initial intravenous (IV) or intramuscular (IM) therapy followed by oral therapy) (5), switch versus parenteral treatment (6) and single dose parenteral followed by oral therapy versus oral (1) or switch therapy (3). There was a variety of short-term and long-term outcomes, but no pooled outcomes showed significant differences. Most included studies were small though and there were few outcomes for combination in a meta-analysis.

Authors' conclusions:

There is no evidence suggesting that oral antibiotic therapy is less effective for treatment of severe UTI than parenteral or initial parenteral therapy. The results of this review suggest that the mode of application does not determine therapeutic success.

This record should be cited as:

Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003237. DOI: 10.1002/14651858.CD003237.pub2

Assessed as up to date:

August 13, 2007

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Primary Review Group:

Renal Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

What is the most effective mode of administration for antibiotic therapy in severe urinary tract infection (UTI)?

Bottom line:

Therapeutic success does not depend on the mode of antibiotic administration. Compared to intramuscular (IM) or intravenous (IV) antibiotics, oral therapy is not shown to be less effective in treating severe UTI and preventing long-term damage in adults and children. Severe UTI is the clinical syndrome of fever, bacteriuria, pyuria and symptoms of UTI (flank pain and dysuria). Using oral antibiotics could reduce costs and inconvenience for patients.

Caveat:

Most included studies were small, ranging from 20 to 387 participants, with over half involving less than 100 patients. Due to different outcome parameters, such as when a cure was deemed to have occurred, few studies were available for combination in a meta-analysis.

Context:

Severe UTI is a common infection in adults and children, and can lead to serious complications, such as hypertension and renal failure.

Cochrane Systematic Review:

Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infection. Cochrane Reviews 2007, Issue 4. Art No : CD003237. DOI :10.1002/14651858. CD003237.pub2. This review contains 15 studies involving 1,743 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Infectious disease > Urinary tract infections > Treatment: lower urinary tract infection

Kidney disease > Urinary tract infections > Treatment: lower urinary tract infection

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

No evidence that oral antibiotic therapy is less effective for treating urinary tract infection than intravenous antibiotics

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