Tommaso Cai1, Irene Tamanini1, Carlo Tascini2, Bela Köves3, Gernot Bonkat4, Mauro Gacci5, Andrea Novelli6, Juan Pablo Horcajada7, Truls E Bjerklund Johansen8, George Zanel9. 1. Department of Urology, Santa Chiara Hospital, Trento, Italy. 2. Department of Infectious Diseases, Cotugno Hospital, Naples, Italy. 3. Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary. 4. Department of Urology, alta uro AG, Basel, Switzerland. 5. Department of Urology, University of Florence, Florence, Italy. 6. Department of Health Sciences, University of Florence, Florence, Italy. 7. Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona, CEXS-Universitat Pompeu Fabra Barcelona, Barcelona, Spain. 8. Department of Urology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 9. Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
PURPOSE: We performed a systematic review and meta-analysis to compare the effectiveness and safety profile of fosfomycin vs comparator antibiotics in women with acute uncomplicated cystitis. MATERIALS AND METHODS: Relevant databases were searched using methods recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We assessed the risk of bias and confounders. The study primary end point was clinical or microbiological success, defined as complete (cure) and/or incomplete resolution of symptoms at the end of treatment (improvement) and/or microbiological eradication. RESULTS: After screening 539 articles 15 were included which recruited a total of 2,295 adult female patients. Of the studies 14 were used for microbiological eradication analysis. We used 11 of the 15 articles in a total of 1,976 patients for clinical resolution and 11 in a total of 1,816 patients for safety outcome analysis. No difference was found for clinical resolution in all comparators combined in 11 randomized controlled trials in a total of 1,976 patients (OR 1.16, 95% CI 0.91-1.49, p=0.13). No difference was found for microbiological eradication in 14 randomized controlled trials in a total of 2,052 patients (OR 1.03, 95% CI 0.83-1.30, p=0.09) or for safety outcome in 11 randomized controlled trials in a total of 1,816 patients (OR 1.17, 95% CI 0.86-1.58, p=0.33). Most adverse effects reported for fosfomycin were transient and single dose therapy seems to have resulted in better patient compliance. CONCLUSIONS: Single dose oral fosfomycin trometamol is equal to comparator regimens in terms of clinical and microbiological effectiveness and safety in women with microbiologically confirmed and/or clinically suspected, acute uncomplicated cystitis. It is associated with high patient compliance.
PURPOSE: We performed a systematic review and meta-analysis to compare the effectiveness and safety profile of fosfomycin vs comparator antibiotics in women with acute uncomplicated cystitis. MATERIALS AND METHODS: Relevant databases were searched using methods recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We assessed the risk of bias and confounders. The study primary end point was clinical or microbiological success, defined as complete (cure) and/or incomplete resolution of symptoms at the end of treatment (improvement) and/or microbiological eradication. RESULTS: After screening 539 articles 15 were included which recruited a total of 2,295 adult female patients. Of the studies 14 were used for microbiological eradication analysis. We used 11 of the 15 articles in a total of 1,976 patients for clinical resolution and 11 in a total of 1,816 patients for safety outcome analysis. No difference was found for clinical resolution in all comparators combined in 11 randomized controlled trials in a total of 1,976 patients (OR 1.16, 95% CI 0.91-1.49, p=0.13). No difference was found for microbiological eradication in 14 randomized controlled trials in a total of 2,052 patients (OR 1.03, 95% CI 0.83-1.30, p=0.09) or for safety outcome in 11 randomized controlled trials in a total of 1,816 patients (OR 1.17, 95% CI 0.86-1.58, p=0.33). Most adverse effects reported for fosfomycin were transient and single dose therapy seems to have resulted in better patient compliance. CONCLUSIONS: Single dose oral fosfomycin trometamol is equal to comparator regimens in terms of clinical and microbiological effectiveness and safety in women with microbiologically confirmed and/or clinically suspected, acute uncomplicated cystitis. It is associated with high patient compliance.
Entities:
Keywords:
bacterial; cystitis; drug resistance; fosfomycin; urinary bladder; women's health
Authors: Ana Garcia-Sangenís; Rosa Morros; Mercedes Aguilar-Sánchez; Laura Medina-Perucha; Alfonso Leiva; Joana Ripoll; Mar Martínez-Pecharromán; Cruz B Bartolomé-Moreno; Rosa Magallon Botaya; Jaime Marín-Cañada; José M Molero; Ana Moragas; Amelia Troncoso; Ramon Monfà; Carl Llor Journal: BMJ Open Date: 2021-11-25 Impact factor: 2.692