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Abstract：
BACKGROUND: Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates remain on the rise. This meta-analysis aims to determine whether non-steroidal anti-inflammatory drugs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics.
METHODS: A systematic literature search in PUBMED, CENTRAL, and ACP databases from inception to April 2021 was conducted to identify randomized controlled trials that compare the use of non-steroidal anti-inflammatory drugs versus antibiotics in non-pregnant women ≥18 years old with uncomplicated lower urinary tract infection. Primary outcomes were symptom resolution of UTI by Day 3 or 4 of intervention, and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis for substantial heterogeneity.
RESULTS: Four RCTs involving 1165 patients were analyzed. The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment (RR: 0.69, 95% CIs [0.55, 0.86], p = 0.0008, I2 = 73%, moderate certainty of evidence). The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], p < 0.00001, I2 = 0%, moderate certainty of evidence). Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77, 95% CIs [1.95, 3.94], p < 0.00001, I2 = 36%, moderate certainty of evidence). Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.16, 95% CIs [2.24, 4.44], p < 0.00001, I2 = 47%, low certainty of evidence).
CONCLUSIONS: Antibiotic treatment was more effective than use of non-steroidal anti-inflammatory drugs for acute uncomplicated lower urinary tract infection with an overall moderate certainty of evidence.
METHODS: A systematic literature search in PUBMED, CENTRAL, and ACP databases from inception to April 2021 was conducted to identify randomized controlled trials that compare the use of non-steroidal anti-inflammatory drugs versus antibiotics in non-pregnant women ≥18 years old with uncomplicated lower urinary tract infection. Primary outcomes were symptom resolution of UTI by Day 3 or 4 of intervention, and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis for substantial heterogeneity.
RESULTS: Four RCTs involving 1165 patients were analyzed. The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment (RR: 0.69, 95% CIs [0.55, 0.86], p = 0.0008, I2 = 73%, moderate certainty of evidence). The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], p < 0.00001, I2 = 0%, moderate certainty of evidence). Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77, 95% CIs [1.95, 3.94], p < 0.00001, I2 = 36%, moderate certainty of evidence). Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.16, 95% CIs [2.24, 4.44], p < 0.00001, I2 = 47%, low certainty of evidence).
CONCLUSIONS: Antibiotic treatment was more effective than use of non-steroidal anti-inflammatory drugs for acute uncomplicated lower urinary tract infection with an overall moderate certainty of evidence.
摘要：
背景：目前的指南推荐经验性抗生素作为单纯性UTI的一线治疗。尽管在治疗中被证明是有益的，抗生素耐药率仍在上升。这项荟萃分析旨在确定非甾体类抗炎药是否可以作为一种有效和安全的选择，用于治疗与抗生素相比，非妊娠妇女中简单的低UTI。
方法：在PUBMED进行系统的文献检索，中部,我们从开始至2021年4月进行了ACP数据库,以确定随机对照试验,这些试验比较了非甾体类抗炎药和抗生素在18岁以上无并发症下尿路感染的非妊娠妇女中的使用情况.主要结果是在干预的第3天或第4天，UTI的症状缓解，和上尿路感染并发症。次要结果包括尽管进行了治疗，但仍保持尿液培养阳性，并且需要另一种挽救性抗生素。使用Mantel-Haenszel和Peto几率方法对二分数据的随机和固定效应模型在95％CI报告，然后对实质性异质性进行敏感性分析。
结果：分析了涉及1165例患者的四个RCT。使用非甾体抗炎药到第3天或第4天症状缓解的概率仅小于抗生素治疗的四分之三(RR:0.69,95%CIs[0.55,0.86],p=0.0008,I2=73%,证据的适度确定性)。使用非甾体抗炎药发生上尿路感染并发症的几率是抗生素的6.49比1(PetoOR:6.49,95%CIs[3.02,13.92],p<0.00001,I2=0%,证据的适度确定性)。二次分析显示，NSAID组比抗生素组有2.77倍更可能有一个阳性的尿液培养的持久性微生物（RR：2.77,95%CIs[1.95,3.94]，p<0.00001,I2=36%,证据的适度确定性)。与抗生素相比，使用非甾体抗炎药治疗由于症状持续或恶化而使用二次或挽救性抗生素的可能性是抗生素的三倍(RR:3.16,95%CIs[2.24,4.44]，p<0.00001,I2=47%,证据的确定性低)。
结论：抗生素治疗比使用非甾体抗炎药治疗急性无并发症下尿路感染更有效，证据总体上是中等确定性的。
方法：在PUBMED进行系统的文献检索，中部,我们从开始至2021年4月进行了ACP数据库,以确定随机对照试验,这些试验比较了非甾体类抗炎药和抗生素在18岁以上无并发症下尿路感染的非妊娠妇女中的使用情况.主要结果是在干预的第3天或第4天，UTI的症状缓解，和上尿路感染并发症。次要结果包括尽管进行了治疗，但仍保持尿液培养阳性，并且需要另一种挽救性抗生素。使用Mantel-Haenszel和Peto几率方法对二分数据的随机和固定效应模型在95％CI报告，然后对实质性异质性进行敏感性分析。
结果：分析了涉及1165例患者的四个RCT。使用非甾体抗炎药到第3天或第4天症状缓解的概率仅小于抗生素治疗的四分之三(RR:0.69,95%CIs[0.55,0.86],p=0.0008,I2=73%,证据的适度确定性)。使用非甾体抗炎药发生上尿路感染并发症的几率是抗生素的6.49比1(PetoOR:6.49,95%CIs[3.02,13.92],p<0.00001,I2=0%,证据的适度确定性)。二次分析显示，NSAID组比抗生素组有2.77倍更可能有一个阳性的尿液培养的持久性微生物（RR：2.77,95%CIs[1.95,3.94]，p<0.00001,I2=36%,证据的适度确定性)。与抗生素相比，使用非甾体抗炎药治疗由于症状持续或恶化而使用二次或挽救性抗生素的可能性是抗生素的三倍(RR:3.16,95%CIs[2.24,4.44]，p<0.00001,I2=47%,证据的确定性低)。
结论：抗生素治疗比使用非甾体抗炎药治疗急性无并发症下尿路感染更有效，证据总体上是中等确定性的。
