简单的尿路感染(UTI)是女性最常见的细菌感染。自1948年以来,已建立了尿液pH值与抗生素(ABs)之间的关系。我们旨在寻找每个抗生素家族的最佳尿液pH值,并评估pH值是否会改变细菌对它们的敏感性。我们包括体外研究和体内研究,包括一种或多种细菌物种,并测试了一种或多种AB在不同pH值下的作用。我们还纳入了简单UTI的随机对照临床试验(RCT)(EAU指南2019定义),根据尿液pH值或使用抗生素加尿液pH调节剂(L-蛋氨酸,维生素C...)与抗生素和安慰剂。Quadas-2工具被用作研究和PRISMA项目集的质量评估,用于系统评价。两位作者独立筛选和评估论文,而另外两名作者分别重复了搜索。第五位研究员充当仲裁者,另一位作者合作担任医院药物顾问。对碱性友好的抗生素是大多数氟喹诺酮类药物,氨基糖苷类,甲氧苄啶.对酸性友好的抗生素是磷霉素,四环素,呋喃妥因和一些β-内酰胺。我们建议用抗菌谱测试进行尿液培养,在酸性和碱性介质中,定义细菌敏感性曲线。没有足够的体内证据支持根据患者的尿液pH值选择抗生素或添加尿液pH调节剂是否会导致更高的治愈率。
Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. Since 1948, the relationship between urinary pH and antibiotics (ABs) has been established. We aimed to search for the best urinary pH for each family of antibiotics and to assess whether pH changes bacterial susceptibility to them. We included in vitro research and in vivo studies including one or more bacterial species and tested the effect of one or more ABs at different pH values. We also included randomized controlled clinical trials (RCTs) in uncomplicated UTI (EAU guidelines 2019 definition), choosing the ABs based on urinary pH or using an antibiotic plus urinary pH modifiers (L-methionine, vitamin C…) vs. an antibiotic and a placebo. Quadas-2 tool was used as a quality assessment of the studies and PRISMA set of items for systematic reviews. Two authors independently screened and evaluated the papers, while two additional authors individually repeated the search. A fifth researcher acted as an arbiter, and another author collaborated as a hospital pharmaceutical consultant. Alkaline-friendly antibiotics are most fluoroquinolones, aminoglycosides, trimethoprim. Acidic-friendly antibiotics are fosfomycin, tetracycline, nitrofurantoin and some β-lactams. We suggest performing urine cultures with antibiogram tests, in both acidic and alkaline media, to define the bacterial susceptibility profile. There is insufficient in vivo evidence to support whether choosing an antibiotic based on a patient\'s urinary pH or adding urinary pH modifiers will lead to a higher cure rate.