Modes of administration of antibiotics for symptomatic severe urinary tract infections

Annette Pohl

doi:10.1002/14651858.CD003237.pub2

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Analysis 1.1

Comparison 1 Switch versus parenteral therapy, Outcome 1 Fever after 48 hours.

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Analysis 1.2

Comparison 1 Switch versus parenteral therapy, Outcome 2 Bacteriological cure under therapy.

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Analysis 1.3

Comparison 1 Switch versus parenteral therapy, Outcome 3 Clinical cure at end of treatment.

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Analysis 1.4

Comparison 1 Switch versus parenteral therapy, Outcome 4 Bacteriological cure at end of treatment.

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Analysis 1.5

Comparison 1 Switch versus parenteral therapy, Outcome 5 Clinical and bacteriological cure at end of treatment.

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Analysis 1.6

Comparison 1 Switch versus parenteral therapy, Outcome 6 Reinfection at end of treatment.

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Analysis 1.7

Comparison 1 Switch versus parenteral therapy, Outcome 7 Clinical and bacteriological cure after interval.

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Analysis 1.8

Comparison 1 Switch versus parenteral therapy, Outcome 8 Relapse after interval.

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Analysis 1.9

Comparison 1 Switch versus parenteral therapy, Outcome 9 Reinfection after interval.

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Analysis 1.10

Comparison 1 Switch versus parenteral therapy, Outcome 10 Renal scarring (DMSA scan) after 6 months.

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Analysis 1.11

Comparison 1 Switch versus parenteral therapy, Outcome 11 Adverse events.

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Analysis 2.1

Comparison 2 Oral versus switch therapy, Outcome 1 Clinical and bacteriological cure under therapy.

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Analysis 2.2

Comparison 2 Oral versus switch therapy, Outcome 2 Clinical and bacteriological cure at end of treatment.

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Analysis 2.3

Comparison 2 Oral versus switch therapy, Outcome 3 Reinfection at end of treatment.

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Analysis 2.4

Comparison 2 Oral versus switch therapy, Outcome 4 Relapse at end of treatment.

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Analysis 2.5

Comparison 2 Oral versus switch therapy, Outcome 5 Clinical and bacteriological cure rate after interval.

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Analysis 2.6

Comparison 2 Oral versus switch therapy, Outcome 6 Reinfection after interval.

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Analysis 2.7

Comparison 2 Oral versus switch therapy, Outcome 7 Relapse after interval.

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Analysis 2.8

Comparison 2 Oral versus switch therapy, Outcome 8 Renal scarring (DMSA scan) after 6 months.

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Analysis 2.9

Comparison 2 Oral versus switch therapy, Outcome 9 Mean time to cessation of fever (hours).

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Analysis 2.10

Comparison 2 Oral versus switch therapy, Outcome 10 Adverse events.

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Analysis 3.1

Comparison 3 Oral versus parenteral therapy, Outcome 1 Bacteriological cure at end of treatment.

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Analysis 3.2

Comparison 3 Oral versus parenteral therapy, Outcome 2 Bacteriological cure after interval.

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Analysis 4.1

Comparison 4 Single shot/oral versus switch therapy, Outcome 1 Clinical cure under therapy.

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Analysis 4.2

Comparison 4 Single shot/oral versus switch therapy, Outcome 2 Bacterial cure under therapy.

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Analysis 4.3

Comparison 4 Single shot/oral versus switch therapy, Outcome 3 Mean time to cessation of fever (days).

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Analysis 4.4

Comparison 4 Single shot/oral versus switch therapy, Outcome 4 Mean time of clinical symptoms (days).

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Analysis 4.5

Comparison 4 Single shot/oral versus switch therapy, Outcome 5 Clinical cure at end of therapy.

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Analysis 4.6

Comparison 4 Single shot/oral versus switch therapy, Outcome 6 Bacterial cure at end of therapy.

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Analysis 4.7

Comparison 4 Single shot/oral versus switch therapy, Outcome 7 Adverse events.

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Analysis 5.1

Comparison 5 Single shot/oral versus oral therapy, Outcome 1 Clinical and bacteriological cure under therapy.

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Analysis 5.2

Comparison 5 Single shot/oral versus oral therapy, Outcome 2 Bacteriological cure under therapy.

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Analysis 5.3

Comparison 5 Single shot/oral versus oral therapy, Outcome 3 Reinfection or relapse after interval.

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Analysis 5.4

Comparison 5 Single shot/oral versus oral therapy, Outcome 4 Adverse events.

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Table 1. Methodological quality of included studies

Study ID	Concealed allocation	Blinding patients	Blinding clinicians	Blinding outcomes	Intention‐to‐treat	Enrolled/evaluated	Dropouts
Baker 2001	Adequate	No	Yes	Yes	No	87/69	4/73 (5%)
Childs 1990	Adequate	No	No	Not stated	No	63/40	7/63 (11%)
Fischbach 1989	Unclear	No	No	Not stated	Not stated	?/20	0%
Francois 1997	Adequate	No	No	Not stated (blinded in case of ambiguity and resolution by third party)	No	147/128	Group 1: 7 (11%) Group 2: 12 (18%)
Gok 2001	Unclear	No	No	Not stated	Not stated	?/54	Unclear
Hoberman 1999	Adequate	No	No	Yes	Yes	306/306‐272 (depending on outcome)	Group 1: 21 (14%) Group 2: 13 (8%)
Millar 1995	Adequate	No	No	Yes	Yes	120/110	Group 1: 3 (5%) Group 2: 7 (12%)
Mombelli 1999	Adequate	No	No	Yes	No	163/141	2/141 (1%)
Montini 2007	Adequate	No	No	Not stated	Not stated	387(=88% sample size)/387	0%
Neuhaus 2008	Adequate	No	No	Yes	No	365/152	86/365 (24%
Noorbakhsh 2004	Unclear	No	No	Yes	No	60/54	0%
Puppo 1989	Unclear	No	No	Not stated	No (Unclear)	100/82 (number included in this review: 38)	0%
Regnier 1989	Unclear	No	No	Not stated	No	97/95 (81 after interval)	Group 1: 6 (12.5%) Group 2: 8 (17%)
Sanchez 2002	Unclear	No	No	Not stated	No	144/105	0%
Vilaichone 2001	Unclear	No	No	Not stated	Yes	36/36	0%

Table 1. Methodological quality of included studies

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Comparison 1. Switch versus parenteral therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Fever after 48 hours Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Bacteriological cure under therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Clinical cure at end of treatment Show forest plot	2	137	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.94, 1.10]

4 Bacteriological cure at end of treatment Show forest plot	2	76	Risk Ratio (M‐H, Random, 95% CI)	1.02 [0.92, 1.13]

5 Clinical and bacteriological cure at end of treatment Show forest plot	4	294	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.94, 1.04]

6 Reinfection at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

7 Clinical and bacteriological cure after interval Show forest plot	3	219	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.89, 1.11]

7.1 Paediatric studies	2	138	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.96, 1.10]
7.2 Adult studies	1	81	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.73, 1.16]
8 Relapse after interval Show forest plot	3	203	Risk Ratio (M‐H, Random, 95% CI)	2.79 [0.30, 25.67]

9 Reinfection after interval Show forest plot	4	239	Risk Ratio (M‐H, Random, 95% CI)	0.76 [0.30, 1.90]

10 Renal scarring (DMSA scan) after 6 months Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

11 Adverse events Show forest plot	4	292	Risk Ratio (M‐H, Random, 95% CI)	0.85 [0.19, 3.83]

11.1 Pediatric studies	3	195	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.30, 1.53]
11.2 Adult studies	1	97	Risk Ratio (M‐H, Random, 95% CI)	12.24 [0.71, 211.37]

Comparison 1. Switch versus parenteral therapy

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Comparison 2. Oral versus switch therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical and bacteriological cure under therapy Show forest plot	3	599	Risk Ratio (M‐H, Random, 95% CI)	1.00 [0.98, 1.02]

2 Clinical and bacteriological cure at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Reinfection at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4 Relapse at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

5 Clinical and bacteriological cure rate after interval Show forest plot	3	493	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.93, 1.01]

6 Reinfection after interval Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1 Symptomatic superinfection	1	287	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.27, 1.67]
6.2 Symptomatic and asymptomatic superinfection	2	341	Risk Ratio (M‐H, Random, 95% CI)	0.64 [0.29, 1.42]
7 Relapse after interval Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

8 Renal scarring (DMSA scan) after 6 months Show forest plot	2	424	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.35, 2.16]

9 Mean time to cessation of fever (hours) Show forest plot	3	834	Mean Difference (IV, Random, 95% CI)	0.40 [‐2.94, 3.74]

10 Adverse events Show forest plot	2	506	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.06, 15.02]

Comparison 2. Oral versus switch therapy

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Comparison 3. Oral versus parenteral therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Bacteriological cure at end of treatment Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Bacteriological cure after interval Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 3. Oral versus parenteral therapy

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Comparison 4. Single shot/oral versus switch therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical cure under therapy Show forest plot	2	225	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.86, 1.02]

2 Bacterial cure under therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Mean time to cessation of fever (days) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

4 Mean time of clinical symptoms (days) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

5 Clinical cure at end of therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

6 Bacterial cure at end of therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

7 Adverse events Show forest plot	2	225	Risk Ratio (M‐H, Random, 95% CI)	4.00 [0.46, 34.75]

Comparison 4. Single shot/oral versus switch therapy

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Comparison 5. Single shot/oral versus oral therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Clinical and bacteriological cure under therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

2 Bacteriological cure under therapy Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Reinfection or relapse after interval Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4 Adverse events Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

Comparison 5. Single shot/oral versus oral therapy

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