抗生素和非抗生素預防治療在女性復發性泌尿道感染降低風險的比較：

系統性文獻回顧與網絡統合分析

周奕儒、張嘉論、蔡曜州、楊緒棣

台北慈濟醫院泌尿科

Comparison of antibiotics and non-antibiotics prophylaxis in reducing risk of recurrent urinary tract infections in women: A systemic literature review and network meta-analysis

Yi-Ju Chou, Chia-Lun Chang, Yao-Chou Tsai, Stephen Shei-Dei Yang

Division of Urology, Taipei Tzu Chi Hospital

Purpose: Recurrent urinary tract infection (rUTI) is common in women and lead to impaired quality of life. This study seeks to compare the effectiveness of various treatments for rUTI through a systematic review and data pooling. Despite the availability of treatments, there is no comprehensive data that compares their effectiveness, making it challenging to identify the best option for clinical use. The study aims to address this issue and provide useful information to guide treatment decisions for rUTI.

Materials and Methods: This is a systematic review and network meta-analysis study. All randomized controlled trials that compared the effectiveness of antibiotic/non-antibiotic therapy with a control group (placebo/antibiotics/non-antibiotics) in preventing uncomplicated rUTI were included. The primary outcome was to evaluate the effectiveness of different treatments in redcing the risk of rUTI. The secondary outcome was to evaluate the safety of each treatment.

Results: The study included a total of 17 studies comprising 2,600 patients with uncomplicated rUTIs. There were significant differences in reducing UTI recurrence in some treatments. Both cranberry (CB) and antibiotic (ABX) showed a lower risk of rUTI than PLB respectively (OR = 0.58, 95% CI = 0.41 to 0.82, p = 0.002) and (OR = 0.07, 95% CI = 0.01 to 0.42, p = 0.002). Treatment ranking from network meta-analysis showed that pentosan polysulfate (PPS) had the lowest rate of rUTI compared to other treatments. Regarding safety, ABX, CB, PPS, and immunoactive agent (OM-89) did not differ significantly from their respective placebo groups. 

Conclusion: Pentosan polysulfate was found to have the lowest risk of recurrence according to the network meta-analysis. The safety profiles of each treatment were similar to their respective placebo groups. However, more research is needed to determine the long-term efficacy and safety of these treatments, especially for new treatments with limited evidence. Clinicians should consider individual patient factors and preferences when making treatment decisions.