Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.
Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.
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DOI：
10.1002/14651858.cd001209.pub2
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发表时间：
2004-01-01
期刊：
影响因子：
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通讯作者：
Perrota, C
中科院分区：
文献类型：
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作者：
Albert, X;Huertas, I;Perrota, C
背景：尿路感染（UTI）是一个常见的卫生保健问题。在健康的非孕妇中，复发性尿路感染（RUTI）被定义为在12个月内出现三次或三次以上的尿路感染。长期抗生素已被建议作为RUTI的预防策略。目的：确定预防性抗生素用于预防成年非孕妇非并发症RUTI的有效性（期间和之后）和安全性。检索策略：我们检索了MEDLINE（1966- 2004年4月），EMBASE（1980- 2003年1月），Cochrane中央对照试验登记册（收录于Cochrane图书馆2004年第1期）和检索文章的参考文献列表。选择标准：任何已发表的随机对照试验，其中抗生素被用作RUTI的预防性治疗。数据收集和分析：两名评论者独立评估试验质量并提取数据。采用随机效应模型进行统计分析，结果以相对危险度（RR）表示，95%置信区间（CI）。主要结果：19项涉及1120名女性的研究符合纳入条件。抗生素与抗生素（10项试验，430名妇女）：在积极预防期间，抗生素组的微生物复发率范围为0至0.9人-年，而安慰剂组为0.8至3.6人-年。一次微生物性复发（MR）的RR为0.21 (95% CI 0.13 ~ 0.34)，支持抗生素和NNT为1.85。临床复发（CRPY）的RR为0.15 （95% CI 0.08 ~ 0.28）。NNT为1.85。预防后发生一次MR的RR为0.82 （95% CI 0.44 ~ 1.53）。严重副作用的RR为1.58 (95% CI 0.47至5.28)，其他副作用的RR为1.78 (CI 1.06至3.00)，这有利于安慰剂。副作用包括阴道和口腔念珠菌感染以及胃肠道症状。抗生素与抗生素（8项试验，513名妇女）：这些试验没有汇总。每周使用培氟沙星比每月更有效。MR的RR为0.31（95% CI 0.19 ~ 0.52）。连续每日服用环丙沙星与性交后服用环丙沙星的MR无显著差异。结论：与安慰剂相比，持续抗生素预防6-12个月降低了预防期间尿路感染的发生率。预防后两项研究显示组间无差异。抗生素组有更多的不良事件。一项随机对照试验比较了性交后与连续每日使用环丙沙星的情况，发现尿路感染发生率无显著差异，这表明可以为性交后感染尿路感染的妇女提供性交后治疗。
BACKGROUND: Urinary tract infection (UTI) is a common health care problem. Recurrent UTI (RUTI) in healthy non-pregnant women is defined as three or more episodes of UTI during a twelve month period. Long-term antibiotics have been proposed as a prevention strategy for RUTI.OBJECTIVES: To determine the efficacy (during and after) and safety of prophylactic antibiotics used to prevent uncomplicated RUTI in adult non-pregnant women.SEARCH STRATEGY: We searched MEDLINE (1966-April 2004), EMBASE (1980-January 2003), Cochrane Central Register of Controlled Trials( in The Cochrane Library Issue 1, 2004) and reference lists of retrieved articlesSELECTION CRITERIA: Any published randomised controlled trial where antibiotics were used as prophylactic therapy in RUTI.DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI).MAIN RESULTS: Nineteen studies involving 1120 women were eligible for inclusion. Antibiotic versus antibiotic (10 trials, 430 women): During active prophylaxis the rate range of microbiological recurrence patient-year (MRPY) was 0 to 0.9 person-year in the antibiotic group against 0.8 to 3.6 with placebo. The RR of having one microbiological recurrence (MR) was 0.21 (95% CI 0.13 to 0.34), favouring antibiotic and the NNT was 1.85. For clinical recurrences (CRPY) the RR was 0.15 (95% CI 0.08 to 0.28). The NNT was 1.85. The RR of having one MR after prophylaxis was 0.82 (95% CI 0.44 to 1.53). The RR for severe side effects was 1.58 (95% CI 0.47 to 5.28) and for other side effects the RR was 1.78 (CI 1.06 to 3.00) favouring placebo. Side effects included vaginal and oral candidiasis and gastrointestinal symptoms. Antibiotic versus antibiotic (eight trials, 513 women): These trials were not pooled. Weekly pefloxacin was more effective than monthly. The RR for MR was 0.31(95% CI 0.19 to 0.52). There was no significant difference in MR between continuous daily and postcoital ciprofloxacin.REVIEWERS' CONCLUSIONS: Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed nodifference between groups. There were more adverse events in the antibiotic group. One RCT compared postcoital versus continuous daily ciprofloxacin and found no significant difference in rates of UTIs, suggesting that postcoital treatment could be offered to woman who have UTI associated with sexual intercourse.