Abstract
Objectives: Uncomplicated Lower Urinary Tract Infections (LUTIs) are the most common source of infection affecting women. The increasing prevalence of antimicrobial resistance to commonly prescribed antibiotics has led to the development and use of novel therapies. This current meta-analysis and systematic review evaluate the use of single-dose Fosfomycin-Trometamol (FMT) versus alternative antimicrobial regimens in the management of uncomplicated LUTI. Methods: This is a systematic review. We included observational studies and Randomized Controlled Trials (RCTs). Studies that investigated the efficacy of fosfomycin or FMT in managing uncomplicated LUTIs in any age group or gender and compared the treatment to any alternative antibiotic regimen were considered eligible. Results: After a comprehensive review of the literature, nineteen studies fulfilled the inclusion criteria. All of the eligible studies (3779 patients) investigated showed no difference between the use of single-dose fosfomycin versus alternative antibiotic regimens for LUTI treatment (OR, 1.003; 95% CI, 0.853-1.181; p = 0.967). The OR remained unchanged but became statistically significant when the random-effects model was used for sensitivity analysis (OR, 1.53; 95% CI, 1.05-2.38; p = 0.04). Conclusion: The meta-analysis revealed that there was no significant difference between single-dose FMT and the commonly prescribed antibiotic regimens in LUTI treatment outcomes such as clinical improvement and microbial eradication.
Highlights
Urinary Tract Infections (UTIs) are one of the most frequently encountered bacterial infections in women [1 - 4], and most commonly present as an acute uncomplicated UTI, relegated to the lower urinary tract
Studies that investigated the efficacy of fosfomycin or FMT in managing uncomplicated Lower Urinary Tract Infections (LUTIs) in any age group or gender and compared the treatment to any alternative antibiotic regimen were considered eligible
Among the 19 studies included in our analysis, 18 compared the use of single-dose fosfomycin versus alternate antibiotics while one study compared two doses of fosfomycin with alternate antibiotics
Summary
Urinary Tract Infections (UTIs) are one of the most frequently encountered bacterial infections in women [1 - 4], and most commonly present as an acute uncomplicated UTI, relegated to the lower urinary tract. Up to 20-30% of adult women will experience at least one UTIs each year [1]. While there are multiple urinary pathogens responsible for UTIs in women, the most common causative microorganism is Escherichia coli (E. coli), which is the etiological agent in 70–90% of all bacterial LUTIs [2 - 5]. The prevalence of antibacterial resistance to antibiotics commonly prescribed for LUTIs varies across countries. These resistance rates are, at least partially, related to the increasingly widespread use of antibiotics [6, 8 - 11].
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