Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis

• Published in: The American journal of medicine Vol. 118; no. 11; p. 1196
• Main Authors: Katchman, Eugene A, Milo, Gai, Paul, Mical, Christiaens, Thierry, Baerheim, Anders, Leibovici, Leonard
• Format: Journal Article
• Language: English
• Published: United States 01-11-2005
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Ambulatory Care; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Bacteriuria - drug therapy; Cystitis - complications; Cystitis - drug therapy; Drug Administration Schedule; Drug Resistance; Evidence-Based Medicine; Female; Follow-Up Studies; Gram-Negative Bacterial Infections - drug therapy; Humans; Middle Aged; Pyelonephritis - etiology; Pyelonephritis - prevention & control; Randomized Controlled Trials as Topic - methods; Randomized Controlled Trials as Topic - statistics & numerical data; Recurrence; Risk; Selection Bias; Staphylococcal Infections - drug therapy; Treatment Outcome
• ISSN: 1555-7162
• DOI: 10.1016/j.amjmed.2005.02.005

We performed a meta-analysis to ascertain the efficacy and safety of the currently practiced 3-day antibiotic therapy for cystitis versus prolonged therapy (5 days or longer) to relieve symptoms and to achieve bacteriological cure.
The Cochrane Library, the Cochrane Renal Group's Register of trials, EMBASE and MEDLINE were searched to identify all randomized controlled trials comparing 3-day oral antibiotic therapy with prolonged therapy (5 days and longer) for uncomplicated cystitis in adult non-pregnant women. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Relative risks (RR) with their 95% confidence intervals (CI) were estimated; a fixed effect model was used. An intention-to-treat analysis was performed whenever possible.
Thirty-two trials and 9605 patients met inclusion criteria. For symptomatic failure rates no difference between 3-day and prolonged antibiotic regimens was found at short term (RR 1.16, 95% CI: 0.96-1.41) and long-term follow-up (RR 1.17, 95% CI: 0.99-1.38). Three-day treatment was less effective than prolonged therapy in preventing bacteriological failure, relative risk 1.37 (95% CI: 1.07-1.74) for short-term follow-up, and 1.47 (95% CI: 1.22-1.77) for long-term follow-up. Adverse effects were more common in the prolonged therapy group (RR 0.83, 95% CI: 0.79-0.91). The results were consistent for subgroup and sensitivity analyses.
Antibiotic therapy for 3 days is similar to prolonged therapy in achieving symptomatic cure for cystitis, while the prolonged treatment is more effective in obtaining bacteriological cure.