A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis

Collection Location Koleksi E-book & E-Journal Perpustakaan Pusat Unila
Edition Vol. 37, Issue. 11
Call Number
ISBN/ISSN 1435-4373
Author(s) Cattrall, Jonathan W. S.
Robinson, Alyss V.
Kirby, Andrew
Subject(s) Biomedicine
Classification NONE
Series Title
GMD E-Journal
Language English
Publisher Springer
Publishing Year 2018
Publishing Place Switzerland
Abstract/Notes Abstract
There is increasing resistance to the oral antibiotics currently recommended for the treatment of pyelonephritis, and increased
healthcare costs are associated with the reliance on alternative intravenous agents.We, therefore, performed a systematic review
of randomised controlled trials to determine the clinical efficacy and safety of oral antibiotics for the treatment of pyelonephritis
in adults. A search of four major medical databases (MEDLINE, Embase+ Embase classic, CENTRAL and Cochrane Database
for Systematic Reviews) in addition to manual reference searching of relevant reviews was conducted. Clinical cure and adverse
event rates were reported, and trial quality and bias were assessed. A total of 277 studies were reviewed; five studies matched all
eligibility criteria and were included. Antibiotics included were cefaclor, ciprofloxacin, gatifloxacin, levofloxacin, lomefloxacin,
loracarbef, norfloxacin, rufloxacin and trimethoprim-sulfamethoxazole. In included studies, the clinical success of the outpatient
treatment of pyelonephritis by cefaclor, ciprofloxacin and norfloxacin at 4 to 6 weeks was comparable at between 83 to 95%.
Relatively high rates of adverse events were noted in a trial of ciprofloxacin (24%) and trimethoprim-sulfamethoxazole (33%).
Significant heterogeneity between all aspects of the trial designs was identified, with all studies having a potential for bias. This
review demonstrates a need for high-quality clinical trials into the oral antibiotic treatment of pyelonephritis, with more consistent
designs and reporting of outcomes. There are data to support further research into oral norfloxacin and cefaclor for the outpatient
treatment of pyelonephritis in adults.
Keywords Pyelonephritis . Urinary tract infection . Antibiotic . Resistance . Oral
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