Long-term efficacy of prophylactic antibiotics and alternative treatments for preventing recurrent uncomplicated female urinary tract infections: A systematic review and network meta-analysis
BAUS ePoster online library. Stroman L. 06/24/19; 259522; P3-8 Disclosure(s)(s): No conflict of interests.
Mr. Luke Stroman
Mr. Luke Stroman
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Continuous antibiotics can be considered for females with recurrent UTI when behavioural measures have failed. We aim to systematically review and conduct a meta-analysis of randomized controlled trials (RCTs) to assess the efficacy of prophylactic long-term antibiotics and non-antibiotic medicines for female patients with recurrent UTI and to evaluate patient safety.

Materials and Methods
We reviewed RCTs that compared prophylaxic antibiotics and/or non-antibiotic agents with placebo in terms of long-term effectiveness and adverse events in preventing recurrent UTI in females. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials (Central), Web of science, and Ovid for relevant studies, published up to August 2018. All outcomes were presented as odds ratios (ORs) with 95% confidence intervals. Both conventional and network meta-analyses (with a frequentist approach) were conducted on R software.

Meta-analysis was completed on 13 RCTs (1279 participants). D-mannose (OR 0.10) had the highest-ranking as therapeutic treatment for 6 months follow-up followed by Nitrofurantoin (OR 0.15) then Trimethoprim/Sulfamethoxazole (OR 0.17). Nitrofurantoin was associated with a higher risk of adverse events compared to other interventions at both 6 months (OR 81.17) and 1 year (OR 5.32). Norfloxacin (OR 0.02) followed by Trimethoprim (OR 0.07) then Nitrofurantoin (OR 0.19) had the highest efficacy for patients with recurrent UTI at 1 year follow up.

D-mannose was seen to be the most effective at 6 months while Norfloxacin was most effective at 1 year. Further prospective randomized controlled trials with large sample size are needed.
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