Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials.
Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials.
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DOI：
10.1136/bmjopen-2016-015233
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发表时间：
2017-05-29
期刊：
影响因子：
2.9
通讯作者：
Paranjothy S
中科院分区：
文献类型：
--
作者：
Ahmed H;Davies F;Francis N;Farewell D;Butler C;Paranjothy S
为了解决长期抗生素治疗预防老年人反复尿路感染(UTIs)的有效性和安全性的临床不确定性。随机试验的系统综述和荟萃分析。我们检索了Medline、Embase、护理和相关健康文献的累积索引(CINAHL)和Cochrane注册的对照试验，从最初到2016年8月。符合条件的研究将65岁以上的男性或女性，或有反复尿路感染的绝经后女性的长期抗生素治疗与非抗生素治疗或安慰剂进行比较。我们没有发现任何包括老年男性在内的研究。三项随机对照试验对绝经后妇女长期服用抗生素与阴道雌激素(n=150)、口服乳酸菌(n=238)和D-甘露糖粉(n=94)进行了比较。长期应用抗生素可将尿路感染复发的风险降低24%(3次试验，n=482；合并风险比(RR)0.76；95%CI 0.61~0.95，需要治疗的次数=8.5)。不良事件的风险无统计学意义的增加(轻度不良事件：合并RR 1.52；95%可信区间0.76至3.03；严重不良事件：合并RR 0.90，95%可信区间0.31至2.66)。一项试验表明，在预防治疗1个 月后，90%的尿液和粪便分离的大肠埃希菌对甲氧苄氨嘧啶-磺胺甲恶唑耐药。来自三个具有相对较短随访期的小规模试验的结果表明，长期使用抗生素治疗可以降低绝经后尿路感染复发的风险。我们没有找到任何证据来告知几个临床上重要的情景，包括老年男性或虚弱的疗养院居民的益处和危害、最佳预防时间、预防停止后的复发率以及对尿路抗生素耐药性的影响。
To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. Systematic review andmeta-analysis of randomised trials. We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature(CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs. We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim–sulfamethoxazole after 1 month of prophylaxis. Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.
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DOI：
10.1136/bmj.b2535
发表时间：
2009-07-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moher D;Liberati A;Tetzlaff J;Altman DG;PRISMA Group
通讯作者：
PRISMA Group
DOI：
10.1002/14651858.cd001209.pub2
发表时间：
2004-01-01
期刊：
The Cochrane database of systematic reviews
影响因子：
--
作者：
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通讯作者：
Perrota, C
影响因子：
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作者：
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通讯作者：
Hughes, Carmel
影响因子：
2.8
作者：
McClean, Pamela;Tunney, Michael;Hughes, Carmel
通讯作者：
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影响因子：
5.2
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