马尿酸乌洛托品预防社区成年女性尿路感染复发的效果的系统评价和荟萃分析

2021-06-17 中国全科医学

对社区成年女性复发性尿路感染患者采用马尿酸乌洛托品预防复发的效果的随机对照试验进行系统综述。

摘要：

背景

临床通常采用抗生素治疗尿路感染, 但是在治疗过程中可能会发生过度使用抗生素的情况。

目的

对社区成年女性复发性尿路感染患者采用马尿酸乌洛托品预防复发的效果的随机对照试验进行系统综述。

设计和开展地点

本研究为系统综述。纳入的随机对照试验在来自英国、澳大利亚、挪威和美国的成年女性复发性尿路感染患者（≥18岁）中开展，对采用马尿酸乌洛托品治疗的患者（马尿酸乌洛托品组）、安慰剂治疗或无治疗的患者（对照组），以及抗生素治疗的患者（抗生素组）预防复发的效果和不良反应进行对比分析。

方法

在3个数据库和临床试验注册中心检索相关随机对照试验研究，并对纳入的研究的参考文献进行正排索引和倒排索引分析。

结果

共纳入6项研究（涉及557例患者，其中的447例被纳入本文分析），其中5项为已发表，另外一项为未发表的试验结果记录。3项研究对比了马尿酸乌洛托品组和安慰剂组或对照组的预防效果和不良反应情况，另外3项对比了马尿酸乌洛托品组和抗生素组的预防效果和不良反应情况。

治疗12个月后，在无症状患者中，马尿酸乌洛托品组预防复发的效果优于抗生素组，但是差异无统计学意义[RR=0.65, 95%CI（0.40，1.07），I2=49%]。治疗6个月或12个月后，在无症状患者中，马尿酸乌洛托品组预防复发的效果优于对照组, 但是差异无统计学意义[RR=0.56, 95% CI （0.13, 2.35）, I2 93%]。治疗12个月后，在非细菌性尿路感染患者中，马尿酸乌洛托品组预防复发的效果优于任何一种抗生素治疗组，但是差异无统计学意义[RR=0.80, 95%CI（0.62，1.03），I2=23%]。

此外，马尿酸乌洛托品组治疗后的尿路感染复发次数和菌尿复发次数均低于对照组，但是差异无统计学意义。马尿酸乌洛托品组发生不良反应的患者数量低于任何一种抗生素治疗组和对照组，但是差异也无统计学意义。各研究对于患者抗生素的应用和抗生素耐药性的发生情况报道不尽一致。

结论

目前尚无足够的证据证明马尿酸乌洛托品对尿路感染有确凿的预防作用。关于其预防尿路感染的有效性及其是否可以作为抗生素预防尿路感染的替代疗法，仍需进一步的研究。

原文网址：

https://doi.org/10.3399/BJGP.2020.0833

原文摘要如下：

Use of methenamine hippurate to prevent urinary tract infections in community adult women: a systematic review and meta-analysis

Abstract

Background Urinary tract infections (UTIs) are often treated with antibiotics and are a source of antibiotic overuse.

Aim To systematically review randomised controlled trials (RCTs) of adult women in the community with a history of recurrent UTIs and who use methenamine hippurate prophylactically.

Design and setting Systematic review of women in the UK, Australia, Norway, and US (aged ≥18 years) with recurrent UTIs receiving methenamine hippurate against placebo or no treatment, and antibiotics.

Method The authors searched three databases, clinical trial registries, and performed forward–backward citation analysis on references of included studies.

Results Six studies involving 557 participants were included (447 were analysed). Of the six studies, five were published and one was an unpublished trial record with results, three compared methenamine hippurate against placebo or control, and three compared methenamine hippurate with antibiotics. For the number of patients who remained asymptomatic, methenamine hippurate showed a non-statistically significant trend of benefit versus antibiotics over 12 months (risk ratio [RR] 0.65, 95% confidence interval [CI] = 0.40 to 1.07, I2 49%), versus control over 6 or 12 months (RR 0.56, 95% CI = 0.13 to 2.35, I2 93%), and a non-statistically significant trend versus any antibiotic for abacteruria (RR 0.80, 95% CI = 0.62 to 1.03, I2 23%). A similar non-statistically significant trend of benefits for methenamine hippurate for the number of UTI or bacteriuric episodes was found, and a non-statistically significant difference in the number of patients experiencing adverse events between methenamine hippurate and any comparator, with a trend towards benefit for the methenamine hippurate, was identified. Antibiotic use and resistance were not consistently reported.

Conclusion There is insufficient evidence to be certain of the benefits of methenamine hippurate to prevent UTI. Further research is needed to test the drug’s effectiveness in preventing UTIs and as an alternative for antibiotic treatment for UTI.