Comparative effectiveness of antimicrobial regimens for urinary tract infections in India: A systematic review and narrative synthesis of randomised controlled trials

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance Pub Date : 2026-12-01 Epub Date: 2026-09-26 DOI:10.1016/j.jgar.2026.09.008

Saibal Das, Mihir Bhatta, Sarnendu Mondal, Mounamukhar Bhattacharjee, Agniva Majumdar, Manoj Kalita, Joydeep Majumder, Sovonlal Mukherjee, Eshita Mondal, Sreyashi Sen, Payal Singh, Muskan Hossain, Manaswini Mondal, Anushka Ghosh, Writama Guha, Shukla Mandal, Asim Saha, Hitesh Tiwari, Indranil Saha, Vikas Dhikav, Prabudh Goel

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引用次数: 0

Abstract

Objective

To evaluate the comparative effectiveness and safety of antimicrobial regimens in urinary tract infections (UTIs) tested in randomised controlled trials conducted in India and to determine whether any clinically coherent quantitative synthesis was justified.

Methods

PubMed, Embase, Scopus, and Cochrane CENTRAL were searched for randomised controlled trials published from January 2010 to June 2025 that evaluated antimicrobial regimens or treatment durations for symptomatic UTIs in India. Two reviewers independently screened records, assessed full texts, extracted study characteristics and outcome-specific denominators, and linked overlapping publications from the same trial. Risk of bias was assessed, and certainty was evaluated using GRADE (PROSPERO: CRD42025635146).

Results

Seven unique randomised trials enrolled or randomised 956 participants. Four trials evaluated different oral regimens for uncomplicated lower UTI, two evaluated ceftriaxone-sulbactam-disodium ethylenediaminetetraacetic acid (CSE) in complicated UTI or acute pyelonephritis against different comparators, and one compared 7 versus 14 days of effective non-fluoroquinolone therapy in selected hospitalised adults with acute pyelonephritis. One observational study was excluded, and two publications from the same CSE-1034 versus ceftriaxone trial were linked to avoid duplicate counting. No exact treatment comparison was replicated across independent trials. Risk of bias was high in three trials and raised some concerns in four. Certainty was low or very low for all comparison-specific conclusions.

Conclusions

The Indian evidence base is sparse and clinically heterogeneous. It neither establishes overall superiority of one antimicrobial nor demonstrates equivalence among regimens. Broader recommendations require larger trials.

查看原文本刊更多论文

印度尿路感染抗菌方案的比较有效性：随机对照试验的系统回顾和叙事综合。

目的：评价在印度进行的随机对照试验中抗菌方案在尿路感染（uti）中的相对有效性和安全性，并确定是否有任何临床一致的定量合成是合理的。方法：检索PubMed、Embase、Scopus和Cochrane CENTRAL检索2010年1月至2025年6月发表的随机对照试验，这些试验评估了印度症状性尿路感染的抗菌方案或治疗时间。两位审稿人独立筛选记录，评估全文，提取研究特征和结果特异性分母，并将同一试验的重叠出版物联系起来。评估偏倚风险，使用GRADE （PROSPERO: CRD42025635146）评估确定性。结果：7个独特的随机试验纳入或随机956名受试者。四项试验评估了不同口服方案治疗非复杂性下尿路感染的效果，两项试验评估了头孢曲松-舒巴坦-乙二胺四乙酸二钠（CSE）治疗复杂尿路感染或急性肾盂肾炎的效果，一项试验比较了急性肾盂肾炎住院成人非氟喹诺酮类药物治疗7天和14天的效果。排除了一项观察性研究，并将同一CSE-1034与头孢曲松试验的两篇出版物联系起来，以避免重复计数。在独立试验中没有精确的治疗比较。有3个试验的偏倚风险很高，有4个试验引起了一些关注。所有特定于比较的结论的确定性都很低或非常低。结论：印度的证据基础稀疏且临床异质性。它既没有确定一种抗菌素的总体优势，也没有证明方案之间的等效性。更广泛的建议需要更大规模的试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

8.70

自引率

2.20%

发文量

285

审稿时长

34 weeks

期刊介绍： The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.