Oral vs initial parenteral treatment (switch therapy) for symptomatic severe urinary tract infections in non-elderly

Oral antibiotic therapy might possibly be as effective as parenteral or initial parenteral therapy for severe urinary tract infection, but because of extremely heterogeneous study populations no conclusions can be made in specific patient groups.

A Cochrane review included 15 studies with a total of 1743 subjects. Initial intravenous or intramuscular therapy followed by oral therapy was defined as switch treatment. Studies compared oral vs switch treatment (5 studies n=1040), switch vs parenteral treatment (6 trials, n=373), and single dose parenteral followed by oral therapy vs oral or switch therapy. There were a variety of short-term and long-term outcomes, but no pooled outcomes showed significant differences. Only one small trial studied oral vs parenteral treatment, parenteral therapy had better bacterial cure than oral norfloxacin. The only assessed long-term outcome was kidney scarring, and scarring does not seem to differ.

Comment: The quality of evidence is downgraded by study quality (many were of suboptimal quality), by imprecise results (limited study size for each comparison) and by indirectness (very heterogeneous patients were pooled in the analysis) .

Ədəbiyyat

1. Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Cochrane Database Syst Rev 2007 Oct 17;(4):CD003237.