title: Comparative effectiveness of antibiotics for uncomplicated urinary tract infections: network meta-analysis of randomized trials.
abstract: BACKGROUND
  The efficacies and adverse effects of different antibiotics for uncomplicated urinary tract infections (UTIs) have been studied by standard meta-analytic methods using pairwise direct comparisons of antimicrobial treatments: the effects of one treatment are compared to those of either another treatment or placebo. However, for clinical decisions, we need to know the effectiveness of each possible treatment in comparison with all relevant alternatives, not with just one.
  
  
  OBJECTIVE
  To compare the efficacies and adverse effects of all relevant antibiotics for UTI treatment simultaneously by performing a network meta-analysis using direct and indirect treatment comparisons.
  
  
  METHODS
  Using logistic regression analysis, we performed a network meta-analysis of randomized controlled trials (RCTs) published after 1999 that compared different oral antibiotic or placebo regimens for UTI treatment in general practice or outpatient settings. We looked at five binary outcomes: early clinical, early bacteriological, late clinical and late bacteriological outcomes, as well as adverse effects. Consequently, a ranking of the antibiotic regimens could be composed.
  
  
  RESULTS
  Using a network structure, we could compare and rank nine treatments from 10 studies. Overall, ciprofloxacin and gatifloxacin appeared the most effective treatments, and amoxicillin-clavulanate appeared the least effective treatment. In terms of adverse effects, there were no significant differences.
  
  
  CONCLUSIONS
  Network meta-analysis shows some clear efficacy differences between different antibiotic treatments for UTI in women. It provides a useful tool for clinical decision making in everyday practice. Moreover, the method can be used for meta-analyses of RCTs across primary care and beyond.
authors.affiliation: Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. b.j.knottnerus@amc.uva.nl
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Knottnerus
authors.forename: Larissa
authors.initials: L
authors.lastname: Grigoryan
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.forename: Theo J M
authors.initials: TJ
authors.lastname: Verheij
authors.forename: Alphons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D014552:Urinary Tract Infections / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents