Comparative effectiveness of oral antibiotic regimens for urinary tract infections in outpatients: a systematic review

Mehnaz Hoda; Sabir Amin Ahmad; Afreen Hoda

doi:10.18203/2319-2003.ijbcp20252586

Authors

Mehnaz Hoda Department of Pharmacology, Arya Bhatta Knowledge University, Patna, Bihar, India
Sabir Amin Ahmad Department of Physiology, Madhya Pradesh Medical Science University, M. P., India
Afreen Hoda Department of Medicine, IGIMS Patna, Bihar, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20252586

Keywords:

Urinary tract infections, Oral antibiotic regimens, Comparative effectiveness, Antibiotic resistance, Outpatient treatment

Abstract

Urinary tract infections (UTIs) are one of the most prevalent bacterial infections encountered in outpatient clinical practice, especially among women. The treatment of uncomplicated UTIs predominantly involves oral antibiotic therapy; however, the increasing prevalence of antimicrobial resistance presents a significant challenge in selecting the most effective regimen. This systematic review critically evaluates and compares the effectiveness and safety of various oral antibiotic regimens used for the treatment of uncomplicated UTIs in outpatient populations. The study synthesizes evidence from randomized controlled trials (RCTs), cohort studies, and observational studies to identify antibiotics that provide superior symptom resolution, microbiological cure, and lower recurrence rates, while considering patient demographics, local antimicrobial resistance patterns, and adverse effect profiles. The findings suggest that fluoroquinolones, particularly norfloxacin and ofloxacin, demonstrate lower treatment failure rates compared to trimethoprim-sulfamethoxazole (TMP-SMX) and ciprofloxacin. However, the review also emphasizes the need for caution in the use of fluoroquinolones due to their associated side effects and rising resistance. This study aims to guide clinicians in making evidence-based antibiotic choices to optimize patient outcomes and support antimicrobial stewardship efforts in outpatient care.

Metrics

Metrics Loading ...

References

Foxman B. Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Am J Med. 2002;113(1):5-13.

Chang CH, Lin JW, Wu LC, Mei-Shu L, Lee-Ming C, Chan KA. Association of thiazolidinediones with liver cancer and colorectal cancer in type 2 diabetes mellitus. Hepatology. 2012;55(5):1462-72.

Chang YT, Lin CH, Lee MC. The National Health Insurance Research Database: An enriched source of real-world evidence for Taiwan. J Epidemiol. 2012;22(5):377-8.

Gilbert DN, Chambers HF, Eliopoulos GM. The Sanford guide to antimicrobial therapy 2024 (54th ed.). Antimicrobial Therapy Inc. 2024.

Gupta K, Hooton TM, Naber KG, Wullt B, Björn W, Richard C, Loren GM, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20.

Gupta K, Hooton TM, Stamm WE, Increasing anti-microbial resistance and the management of uncomplicated community acquired urinary trac infection Ann Intern Med. 2001;135:41-50.

Joint Formulary Committee. British National Formulary (BNF). BMJ Group and Pharmaceutical Press. 2024. Available at: https://bnf.nice.org.uk. Accessed on 15 April 2025.

Knottnerus BJ, Geerlings SE, Moll van Charante EP. Women with recurrent urinary tract infections: Quality of life, treatment preferences and the potential value of preventive antibiotic therapy. BMC Family Practice. 2012;13(1):39.

Knottnerus BJ, Grigoryan L, Geerlings SE, Moll van Charante EP, Verheij TJM, Kessels AGH, et al. Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: Network meta-analysis of randomized trials. Family Pract. 2012;29(6):659-70.

Lee MG, Lee SH, Chang SS, Si-Huei L, Matthew L, Cheng-Chung F, et al. Comparative effectiveness of different oral antibiotics regimens for treatment of urinary tract infection in outpatients: An analysis of national representative claims database. Medicine (Baltimore). 2014;93(28):e304.

Lee C, Hong CH MY, Tang HJ, Ko WC. Comparative effectiveness of oral antibiotics for urinary tract infection in outpatient settings: A retrospective cohort study. BMJ Open. 2014;4(8):e005208.

Madaras-Kelly K, Boyd J, Bond L. Comparative effectiveness of oral antibiotics to treat urinary tract infections in male and female outpatients. Open Forum Infect Dis. 2023;10(2):ofad500.2444.

Madaras-Kelly KJ, Remington RE, Crnich CJ. Comparative effectiveness and safety of oral antibiotics for uncomplicated urinary tract infections in women: A systematic review. Ann Internal Med. 2023;176(3):393-404.

National Institute for Health and Care Excellence. (2018). Urinary tract infection (lower): Antimicrobial prescribing NICE guideline NG109. 2018. Available at: https://www.nice.org.uk/guidance/ng109. Accessed on 15 April 2025.

Novelli A, Rosi E. Norfloxacin in the treatment of urinary tract infections: A review. Drugs. 2017;34(2):111-25.

Novelli A, Rosi E. Pharmacological properties of oral antibiotics for the treatment of uncomplicated urinary tract infections. J Chemotherapy. 2017;29(1):10-8.

World Health Organization. Global antimicrobial resistance and use surveillance system (GLASS) report: 2021. Available at: https://www.who.int/publications/i/item/9789240027336. Accessed on 15 April 2025.

Dinh A, Davido B, Etienne M, Bouchand F, Raynaud-Lambinet A, Aslangul-Castier E, et al. Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial. Europ J Clin Microbiol Infect Dis. 2017;36(8):1443-8.

Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Internal Med. 2017;177(9):1308-15.

Hanretty AM, Gallagher JC. Shortened courses of antibiotics for bacterial infections: A systematic review of randomized controlled trials. Pharmacotherapy. 2018;38(6):674-87.

Fox MT, Melia MT, Same RG, Conley AT, Tamma PD. A seven-day course of TMP-SMX may be as effective as a seven-day course of ciprofloxacin for the treatment of pyelonephritis. Am J Med. 2017;130(7):842-5.

Malmros K, Huttner BD, McNulty C, Rodríguez-Baño J, Pulcini C, Tängdén T. Comparison of antibiotic treatment guidelines for urinary tract infections in 15 European countries: Results of an online survey. Int J Antimicrobial Agents. 2019;54(4):478-86.