Clinical Question

What is the best antibiotic for the treatment of uncomplicated lower urinary tract infection (UTI)?

Bottom Line

This network meta-analysis found that the antibiotics commonly used to treat lower UTI are similar in efficacy, with one exception: amoxicillin/clavulanate (Augmentin) is significantly less effective than the others. (Level of Evidence = 1a)

Synopsis

A network meta-analysis is a technique that allows a researcher to compare two treatments via a common comparison group. For example, if one study compared drug A with drug B, and a second study compared drug B with drug C, a network meta-analysis allows us to indirectly compare drug A with drug C. This study compared antibiotics for the treatment of lower UTI. After a careful search, a total of 10 studies comparing eight antibiotics were identified. The authors looked at microbiologic and clinical outcomes; the most important were short-term and long-term clinical cures and adverse effects. The authors included studies of symptomatic women with available culture results, and they combined different durations of therapy for a given antibiotic into a single arm of the network meta-analysis. The short-term and long-term clinical cure rates were not significantly different among trimethoprim/sulfamethoxazole, norfloxacin (Noroxin), nitrofurantoin (Furadantin), and gatifloxacin (Tequin); amoxicillin/clavulanate, however, was less effective. Ciprofloxacin (Cipro) and gatifloxacin were somewhat more effective in the short term. Harms were similar among the drugs.

Reference

KnottnerusBJGrigoryanLGeerlingsSEet alComparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials. Fam Pract.2012; 29( 6): 659– 670.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)