Fosfomycin Trometamol versus Comparator Antibiotics for the Treatment of Acute Uncomplicated Urinary Tract Infections in Women: A Systematic Review and Meta-Analysis

No AccessJournal of UrologyAdult Urology1 Mar 2020Fosfomycin Trometamol versus Comparator Antibiotics for the Treatment of Acute Uncomplicated Urinary Tract Infections in Women: A Systematic Review and Meta-AnalysisThis article is commented on by the following:Editorial CommentEditorial Comment Tommaso Cai, Irene Tamanini, Carlo Tascini, Bela Köves, Gernot Bonkat, Mauro Gacci, Andrea Novelli, Juan Pablo Horcajada, Truls E. Bjerklund Johansen, and George Zanel Tommaso CaiTommaso Cai *Correspondence: Department of Urology, Santa Chiara Hospital, Largo Medaglie d'Oro 9, Trento, Italy telephone: +39 0461 903306 or +39 3339864943; FAX: +39 0461 903101; E-mail Address: [email protected] Department of Urology, Santa Chiara Hospital, Trento, Italy , Irene TamaniniIrene Tamanini Department of Urology, Santa Chiara Hospital, Trento, Italy , Carlo TasciniCarlo Tascini Department of Infectious Diseases, Cotugno Hospital, Naples, Italy , Bela KövesBela Köves Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary , Gernot BonkatGernot Bonkat Department of Urology, alta uro AG, Basel, Switzerland , Mauro GacciMauro Gacci Department of Urology, University of Florence, Florence, Italy , Andrea NovelliAndrea Novelli Department of Health Sciences, University of Florence, Florence, Italy , Juan Pablo HorcajadaJuan Pablo Horcajada 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 , Truls E. Bjerklund JohansenTruls E. Bjerklund Johansen Department of Urology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway , and George ZanelGeorge Zanel Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada View All Author Informationhttps://doi.org/10.1097/JU.0000000000000620AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1. : Appropriate use of antibiotics: an unmet need. Ther Adv Urol 2019; 11: 1756287219832174. Google Scholar 2. : EAU Guidelines on Urological Infections. Available at https://uroweb.org/guideline/urological-infections/. Accessed April 21, 2019. Google Scholar 3. : 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: e103. 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The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologyDec 19, 2019, 12:00:00 AMEditorial CommentJournal of UrologyDec 19, 2019, 12:00:00 AMEditorial Comment Volume 203Issue 3March 2020Page: 570-578Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsbacterialwomen's healthfosfomycindrug resistanceurinary bladdercystitisMetricsAuthor Information Tommaso Cai Department of Urology, Santa Chiara Hospital, Trento, Italy *Correspondence: Department of Urology, Santa Chiara Hospital, Largo Medaglie d'Oro 9, Trento, Italy telephone: +39 0461 903306 or +39 3339864943; FAX: +39 0461 903101; E-mail Address: [email protected] More articles by this author Irene Tamanini Department of Urology, Santa Chiara Hospital, Trento, Italy More articles by this author Carlo Tascini Department of Infectious Diseases, Cotugno Hospital, Naples, Italy More articles by this author Bela Köves Department of Urology, South-Pest Teaching Hospital, Budapest, Hungary More articles by this author Gernot Bonkat Department of Urology, alta uro AG, Basel, Switzerland More articles by this author Mauro Gacci Department of Urology, University of Florence, Florence, Italy More articles by this author Andrea Novelli Department of Health Sciences, University of Florence, Florence, Italy More articles by this author Juan Pablo Horcajada 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 Financial interest and/or other relationship with Zambon, MSD, Pfizer and Astellas. More articles by this author Truls E. Bjerklund Johansen Department of Urology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway More articles by this author George Zanel Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada More articles by this author Expand All No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Advertisement Loading ...