Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women
Editorial Group: Cochrane Renal Group
Published Online: 16 JUL 2008
Assessed as up-to-date: 6 MAY 2008
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Lutters M, Vogt-Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001535. DOI: 10.1002/14651858.CD001535.pub2.
- Publication Status: Edited (conclusions changed)
- Published Online: 16 JUL 2008
Urinary tract infections (UTI) are common in elderly patients. Authors of non systematic literature reviews often recommend longer treatment durations (7 to 14 days) for older women, but the evidence for such recommendations is unclear.
To determine the optimal duration of antibiotic treatment for uncomplicated symptomatic lower UTI in elderly women.
We contacted known investigators and pharmaceutical companies, screened reference lists of identified articles, reviews and books, and searched MEDLINE, EMBASE, CINAHL, Healthstar, Popline, Gerolit, Bioethics Line, The Cochrane Library, Dissertation Abstracts International and Index to Scientific & Technical Proceedings without language restriction.
Date of most recent search: 7 May 2008.
All randomised controlled trials (RCTs) comparing different treatment durations of oral antibiotics for uncomplicated symptomatic lower UTIs in elderly women were included. Whenever possible we obtained outcome data for older women included in studies with a broader age range. We excluded patients with fever, flank pain or complicating factors; studies with treatment durations longer than 14 days and prevention studies.
Data collection and analysis
The two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and results expressed as risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).
Fifteen studies (1644 elderly women) were included. Three studies compared single dose with short-course treatment (3 to 6 days), six compared single dose with long-course treatment (7 to 14 days) and six compared short- with long-course treatment. Methodological quality of all studies was low except for a more recent geriatric study. There was a significant difference for persistent UTI between single dose and short-course treatment (RR 2.01, 95% CI 1.05 to 3.84) and single versus long-course treatment (RR 1.93, 1.01 to 3.70 95% CI), in the short-term (< 2 weeks post-treatment) but not at long-term follow-up or on clinical outcomes. Patients preferred single dose treatment (RR 0.73, 95% CI 0.60 to 0.88) to long-course treatments, but this was based on one study comparing different antibiotics. Short versus longer treatments showed no significant difference in efficacy. Rate of adverse drug reactions increased significantly with longer treatment durations in only one study.
Short-course treatment (3 to 6 days) could be sufficient for treating uncomplicated UTIs in elderly women, although more studies on specific commonly prescribed antibiotics are needed.
Plain language summary
Antibiotic duration for treating uncomplicated symptomatic lower urinary tract infection in elderly women
As people age (especially women), they become more prone to infections in the bladder (UTI - urinary tract infections). Older people are more likely to have adverse reactions to drugs. Up to the present time older women with uncomplicated UTI were treated longer than younger patients - without any scientific evidence and with an increased risk of adverse drug reactions. We defined three groups of treatment durations: single-dose, short (3 to 6 days) and longer courses (7 to 14 days).
We identified 15 studies (1644 elderly women) comparing single dose, short-course (3 to 6 days) and long course (7 to 14 days) antibiotic treatment for uncomplicated symptomatic UTI in elderly women. Our review suggests that single dose treatments are less effective than short or long courses, but better accepted by the patients. On the other hand longer courses may have more side effects. On the basis of the evidence available at present, an antibiotic treatment of 3 to 6 days could be sufficient for treating uncomplicated UTIs in elderly women, although more studies on specific, commonly prescribed antibiotics are needed.
泌尿道感染 (UTI) 在老年病患是常見的疾病，非系統性綜論文獻的作者通常建議針對老年女性病患，須較長的治療期間 (7到14天) 。但是，對於這樣的建議並無足夠的科學證據。
我們接觸一些研究者及藥廠，搜尋已發表文章、書籍的參考文獻及調查下列的資料庫:MEDLINE, EMBASE, CINAHL, HECLTHSTAR, POPLINE, GEZOLIT, BIOETHICS LINE, The Cochrane Library, Dissectation Abstract International及Index to Scientific&Technical Proceeding這些資料庫的搜尋並無語言限制。最近的搜尋日期:2004年01月08日
兩位研究者分別獨立的評估試驗品質並摘錄資料，使用隨機作用的模式來做統計分析，相關的結果以95% 的信賴區間 (CI) 預後的相對風險性 (RR) 來呈現
共13個試驗包含1435位老年女性，6個試驗比較短時間單一劑量的治療，3個試驗比較單一劑量長時間的治療及4個試驗比較短時間與長時間的效果。所有試驗的方法學品質均很低，在短時間治療後 (2星期) ，長時間組 (3到14天) 比單一劑量組有較佳的持續性的菌尿症比率 (相對風險1.84,95% 的信賴區間1.18至2.86) 。然而，這二組在治療後長時間的持續性菌尿症的比例及臨床治癒率無顯著的差別。根據比較不同的抗生素臨床試驗發現，病患較喜歡單一劑量的治療 (相對風險0.73,95% 的信賴區間0.66至0.88) 短時間治療與長時間治療結果並無差別，但這些研究的數目及樣本均太小
單一劑量抗生素治療與長時間治療 (3到14天) 相比，也許效果較差但較容易被接受，短期抗生素與長期抗生素治療結果並無不同。所選入研究的方法學品質不佳而無法決定最佳的治療期間，故仍須更適當的隨機對照試驗 (RCTs) 來檢測相關臨床的預後及抗生素治療時間。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。