Australia: New antibiotics are similar to carbapenems in terms of safety and clinical response for the treatment of complicated urinary tract infections (cUTIs), according to a recent study published in the journal Open Forum Infectious Diseases. But neww antibiotic treatments showed a superior microbiological response compared to carbapenems.
This systematic review and meta-analysis by Yukiko Ezure, University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia, and colleagues evaluated the clinical efficacy and safety of carbapenems for the treatment of cUTIs with the comparators being new antibiotics evaluated for this indication.
The researchers searched 13 electronical databases for published randomised controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed by using the PICOS framework.
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Key findings of the study include:
Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favour the new antibiotic groups, although this is not statistically significant [risk ratio (RR)=0.91].
A pooled estimate examining clinical response alone showed no difference between treatment arms (RR=1.00), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR=0.85).
New antibiotic treatments demonstrated a superior microbiological response compared to carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance.
"We feel it is likely that drugs with antianaerobic activity, like carbapenems, have a deleterious effect on the vaginal flora. This may predispose a patient to microbiologic recurrence," Ezure said. "This effect of antibiotics on the vaginal microbiome needs to be prospectively evaluated to determine if its significance extends to other drugs which act on the anaerobic flora, including amoxicillin/clavulanate and piperacillin/tazobactam."
"New antibiotic treatments demonstrated a superior microbiological response compared to carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from carbapenems," concluded the authors.
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"Efficacy and safety of carbapenems versus new antibiotics for treatment of adult patients with complicated urinary tract infections: A systematic review and meta-analysis," is published in the journal Open Forum Infectious Diseases.
DOI: https://academic.oup.com/ofid/advance-article/doi/10.1093/ofid/ofaa480/5920690