Single‐dose antibiotic therapy for urinary infections during pregnancy: A systematic review and meta‐analysis of randomized clinical trials

Abstract

Background During pregnancy, urinary infections are an important cause of maternofetal morbidity and mortality and may lead to several complications. Objective To verify whether the use of antibiotic therapy in a single dose when compared with multiple doses in lower tract urinary infections during pregnancy is effective to obtain microbiologic cure. Search strategy Online databases were searched. Keywords used were "single‐drug dose", "antibiotic", "fosfomycin", "amoxicillin", "trimethoprim", "pregnancy", and "urinary tract infection". Selection criteria Studies were included if they were randomized controlled trials, the population was pregnant woman, microbiologic cure was attained, and one of the treatment groups received single‐dose antibiotic therapy. Data collection and analysis Preselected studies have been independently read by pairs, and data were extracted according to a predetermined sheet. The Cochrane tool was used for the risk of bias. Main results A total of 1063 women from nine studies were included. The primary outcome was the microbiologic cure attested by urine culture. When compared with the multiple‐day use of antibiotics, the single‐dose treatment has shown statistically similar results in reaching culture cure (odds ratio 1.02, 95% confidence interval 0.73–1.44). Conclusion The current study has shown that the use of single‐dose treatment for lower tract urinary infections during pregnancy can be recommended, especially using fosfomycin. Systematic review registration This review has not been registered.

Urinary Tract Infections in Pregnant Individuals

“…There is insufficient evidence to recommend a 3-day treatment duration for acute cystitis in pregnancy. However, several studies have evaluated single-dose fosfomycin compared with longer courses of antibiotics for treatment of UTI (40). Results of a meta-analysis found that single-dose fosfomycin has similar clinical outcomes compared with other antibiotic regimens and could be an effective treatment with higher compliance (27,40).…”

“…However, several studies have evaluated single-dose fosfomycin compared with longer courses of antibiotics for treatment of UTI (40). Results of a meta-analysis found that single-dose fosfomycin has similar clinical outcomes compared with other antibiotic regimens and could be an effective treatment with higher compliance (27,40). Regarding any potential teratogenicity of fosfomycin, initial studies have not identified an increased risk of adverse pregnancy effects (41,42).…”

Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients

“… 8 Even single doses of some antibiotics (for example, fosfomycin) could be effective in certain contexts. 11 , 12 A recent addendum to the UK national action plan for tackling AMR has highlighted the need for clinical research comparing antibiotic course lengths and their impact on patients and AMR. 13 Therefore, a second possible way to reduce antibiotic exposure and use could involve shortening the recommended antibiotic courses.…”