Short versus long antibiotic treatment for pyelonephritis and complicated urinary tract infections: a living systematic review and meta-analysis of randomized controlled trials
Abstract
OBJECTIVES
To compile evidence on the durations of treatment for pyelonephritis or febrile complicated urinary tract infection (cUTI) in a living systematic review.
DATA SOURCES
PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to November 30, 2024, trial registries, and conference proceedings. Living review searches will be updated monthly and the evidence yearly. Updates will be available at https://github.com/LivingSystematicReview/Pyelonephritis-KeepItShort.
STUDY ELIGIBILITY
We included randomized controlled trials (RCTs) involving adults with pyelonephritis or cUTI with system signs (mainly fever). The primary outcome was clinical success by day 7 after end of treatment.
INTERVENTIONS
Different treatment durations within the same antibiotic class or treatment strategy (e.g. physicians' selected, in-vitro-matching antibiotics).
RISK OF BIAS
Assessment was conducted using the Cochrane ROB 2.0 tool.
DATA SYNTHESIS
Risk ratios (RR) were compiled using the fixed effect model and certainty of evidence was assessed using GRADE. Subgroups of interest were assessed.
RESULTS
Sixteen RCTs were included, comprising 4,643 patients. Treatment durations of 5-7 days vs. 10-14 days were compared in 12 trials. There was some risk of bias concern in most trials, mainly due to dropouts and lack of blinding. There was no significant difference between short and long treatment durations for clinical success (RR 1.01, 95% CI 0.98-1.04,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 4,643 participants or records.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.