Treatments for symptomatic urinary tract infections during pregnancy

Juan C Vazquez; José Villar

doi:10.1002/14651858.CD002256

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Analysis 1.1

Comparison 1 Intravenous + oral antibiotics versus intravenous only, Outcome 1 Cure rates.

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Analysis 1.2

Comparison 1 Intravenous + oral antibiotics versus intravenous only, Outcome 2 Recurrent infection.

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Analysis 2.1

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 1 Cure rates.

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Analysis 2.2

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 2 Recurrent infection.

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Analysis 2.3

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 3 Preterm delivery.

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Analysis 2.5

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 5 Admission to neonatal intensive care unit.

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Analysis 2.6

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 6 Need for change antibiotic.

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Analysis 2.7

Comparison 2 Outpatient versus inpatient antibiotics, Outcome 7 Incidence of prolonged pyrexia.

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Analysis 3.1

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 1 Cure rates.

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Analysis 3.2

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 2 Recurrent infection.

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Analysis 3.3

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 3 Preterm delivery.

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Analysis 3.5

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 5 Admission to neonatal intensive care unit.

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Analysis 3.6

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 6 Need for change antibiotic.

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Analysis 3.7

Comparison 3 Intravenous cephazolin versus intravenous ampicillin + gentamicin, Outcome 7 Incidence of prolonged pyrexia.

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Analysis 4.1

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 1 Cure rates.

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Analysis 4.2

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 2 Recurrent infection.

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Analysis 4.3

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 3 Preterm delivery.

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Analysis 4.5

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 5 Admission to neonatal intensive care unit.

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Analysis 4.6

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 6 Need for change antibiotic.

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Analysis 4.7

Comparison 4 Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin, Outcome 7 Incidence of prolonged pyrexia.

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Analysis 5.1

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 1 Cure rates.

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Analysis 5.2

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 2 Recurrent infection.

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Analysis 5.3

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 3 Preterm delivery.

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Analysis 5.5

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 5 Admission to neonatal intensive care unit.

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Analysis 5.6

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 6 Need for change antibiotic.

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Analysis 5.7

Comparison 5 Intramuscular ceftriaxone versus intravenous cephazolin, Outcome 7 Indicence of prolonged pyrexia.

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Analysis 6.1

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 1 Cure rates.

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Analysis 6.2

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 2 Recurrent infection.

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Analysis 6.3

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 3 Preterm delivery.

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Analysis 6.6

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 6 Need for change antibiotic.

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Analysis 6.8

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 8 Birthweight < 2500 g.

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Analysis 6.9

Comparison 6 Cephalosporins once‐a‐day versus multiple doses, Outcome 9 Intrauterine growth retardation.

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Analysis 7.1

Comparison 7 Oral ampicillin versus oral nitrofurantoin, Outcome 1 Cure rates.

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Analysis 7.2

Comparison 7 Oral ampicillin versus oral nitrofurantoin, Outcome 2 Recurrent infection.

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Analysis 7.6

Comparison 7 Oral ampicillin versus oral nitrofurantoin, Outcome 6 Need for change antibiotic.

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Analysis 8.1

Comparison 8 Intravenous and oral cephradine versus intravenous and oral cefuroxime, Outcome 1 Cure rates.

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Analysis 8.2

Comparison 8 Intravenous and oral cephradine versus intravenous and oral cefuroxime, Outcome 2 Recurrent infection.

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Analysis 9.1

Comparison 9 Oral fosfomicin trometamol versus oral ceftibuten, Outcome 1 Cure rates.

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Analysis 10.1

Comparison 10 Single versus multiple dose of gentamicin, Outcome 1 Cure rates.

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Comparison 1. Intravenous + oral antibiotics versus intravenous only

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	67	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.43 [0.46, 12.90]

2 Recurrent infection Show forest plot	1	67	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.81 [0.45, 7.31]

3 Preterm delivery	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antibiotic	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Incidence of prolonged pyrexia	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Intravenous + oral antibiotics versus intravenous only

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Comparison 2. Outpatient versus inpatient antibiotics

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	2	212	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.46 [0.55, 3.92]

2 Recurrent infection Show forest plot	2	212	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.66 [0.19, 2.34]

3 Preterm delivery Show forest plot	2	204	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.05 [0.32, 3.49]

4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit Show forest plot	1	84	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.72 [0.21, 2.42]

6 Need for change antibiotic Show forest plot	2	212	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.85 [0.28, 2.60]

7 Incidence of prolonged pyrexia Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.13 [0.02, 0.94]

Comparison 2. Outpatient versus inpatient antibiotics

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Comparison 3. Intravenous cephazolin versus intravenous ampicillin + gentamicin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.26 [0.28, 5.77]

2 Recurrent infection Show forest plot	1	107	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.56 [0.34, 7.19]

3 Preterm delivery Show forest plot	1	107	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.97 [0.47, 8.29]

4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit Show forest plot	1	107	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.50 [0.57, 3.95]

6 Need for change antibiotic Show forest plot	1	118	Peto Odds Ratio (Peto, Fixed, 95% CI)	7.78 [0.48, 125.98]

7 Incidence of prolonged pyrexia Show forest plot	1	120	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.70 [0.19, 2.53]

Comparison 3. Intravenous cephazolin versus intravenous ampicillin + gentamicin

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Comparison 4. Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	121	Peto Odds Ratio (Peto, Fixed, 95% CI)	3.29 [0.55, 19.58]

2 Recurrent infection Show forest plot	1	109	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.10 [0.21, 5.68]

3 Preterm delivery Show forest plot	1	109	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.10 [0.21, 5.68]

4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit Show forest plot	1	109	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.59 [0.62, 4.11]

6 Need for change antibiotic Show forest plot	1	121	Peto Odds Ratio (Peto, Fixed, 95% CI)	8.19 [1.13, 59.68]

7 Incidence of prolonged pyrexia Show forest plot	1	121	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.06 [0.32, 3.46]

Comparison 4. Intramuscular ceftriaxone versus intravenous ampicillin + gentamicin

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Comparison 5. Intramuscular ceftriaxone versus intravenous cephazolin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	117	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.84 [0.39, 20.70]

2 Recurrent infection Show forest plot	1	102	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.71 [0.15, 3.26]

3 Preterm delivery Show forest plot	1	102	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.56 [0.13, 2.36]

4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit Show forest plot	1	102	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.06 [0.42, 2.68]

6 Need for change antibiotic Show forest plot	1	117	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.97 [0.38, 10.12]

7 Indicence of prolonged pyrexia Show forest plot	1	117	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.51 [0.42, 5.51]

Comparison 5. Intramuscular ceftriaxone versus intravenous cephazolin

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Comparison 6. Cephalosporins once‐a‐day versus multiple doses

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	178	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.72 [0.42, 7.09]

2 Recurrent infection Show forest plot	1	122	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.72 [0.16, 3.27]

3 Preterm delivery Show forest plot	1	178	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.11 [0.41, 3.01]

4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antibiotic Show forest plot	1	178	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.58 [0.14, 2.39]

7 Incidence of prolonged pyrexia	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
8 Birthweight < 2500 g Show forest plot	1	178	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.13 [0.39, 3.24]

9 Intrauterine growth retardation Show forest plot	1	178	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.77 [0.20, 2.95]

Comparison 6. Cephalosporins once‐a‐day versus multiple doses

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Comparison 7. Oral ampicillin versus oral nitrofurantoin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	86	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.79 [0.21, 2.93]

2 Recurrent infection Show forest plot	1	86	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.58 [0.50, 4.96]

3 Preterm delivery	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Premature rupture of membranes	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antibiotic Show forest plot	1	86	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.25 [0.21, 7.61]

7 Incidence of prolonged pyrexia	0	0	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 7. Oral ampicillin versus oral nitrofurantoin

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Comparison 8. Intravenous and oral cephradine versus intravenous and oral cefuroxime

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	101	Odds Ratio (M‐H, Fixed, 95% CI)	0.39 [0.16, 0.93]

2 Recurrent infection Show forest plot	1	101	Odds Ratio (M‐H, Fixed, 95% CI)	2.57 [1.07, 6.17]

3 Preterm delivery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Premature rupture of membranes	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antibiotic	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Incidence of prolonged pyrexia	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 8. Intravenous and oral cephradine versus intravenous and oral cefuroxime

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Comparison 9. Oral fosfomicin trometamol versus oral ceftibuten

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	41	Odds Ratio (M‐H, Fixed, 95% CI)	2.22 [0.19, 26.63]

2 Recurrent infection	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Preterm delivery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Premature rupture of membranes	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antobiotic	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Incidence of prolonged pyrexia	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 9. Oral fosfomicin trometamol versus oral ceftibuten

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Comparison 10. Single versus multiple dose of gentamicin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Cure rates Show forest plot	1	106	Odds Ratio (M‐H, Fixed, 95% CI)	0.24 [0.01, 5.17]

2 Recurrent infection	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
3 Preterm delivery	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
4 Premature rupture of membranes	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
5 Admission to neonatal intensive care unit	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
6 Need for change antibiotic	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
7 Incidence of prolonged pyrexia	0	0	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 10. Single versus multiple dose of gentamicin

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