Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Sep 18, 2020; 10(3): 33-41
Published online Sep 18, 2020. doi: 10.5495/wjcid.v10.i3.33
Antibiotics for complicated urinary tract infection and acute pyelonephritis: A systematic review
Leong Tung Ong
Leong Tung Ong, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
Author contributions: Ong LT designed the literature search, performed the search, analysed the data, wrote the paper, and approved the final manuscript.
Conflict-of-interest statement: The author declares that he has no competing interests.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Leong Tung Ong, MBBS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Kuala Lumpur 50603, Malaysia.
Received: April 19, 2020
Peer-review started: April 19, 2020
First decision: July 8, 2020
Revised: July 8, 2020
Accepted: August 1, 2020
Article in press: August 1, 2020
Published online: September 18, 2020
Research background

Antibiotics that are recommended by the current clinical guidelines may not be effective for treatment of complicated urinary tract infection (UTI) and acute pyelonephritis, due to the increasing resistance rates to the antibiotics.

Research motivation

This systematic review is intended to provide comprehensive information to help clinicians in determining suitable antibiotics for the management of complicated UTI and acute pyelonephritis.

Research objectives

The aim of this study was to determine the clinical efficacy and safety of antibiotics for the treatment of complicated UTI and pyelonephritis.

Research methods

A search of three medical literature databases (PubMed, EMBASE and Google Scholar) was conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis. The following keywords were used to perform the literature search: “urinary tract infection”, “complicated UTI”, “pyelonephritis”, “treatment”, and “antibiotics”. Eligibility criteria included diagnosis of either complicated UTI or acute pyelonephritis and use of antibiotics in management. Clinical trials and observational studies were included in this review, while case reports and reviews were excluded.

Research results

Eight studies matched all the eligibility criteria and were included in this review. The antibiotics included in those studies were ceftazidime-avibactam, doripenem, levofloxacin, meropenem-vaborbactam, piperacillin-tazobactam, plazomicin, tazobactam-ceftolozane, and gentamicin. The clinical data have shown that shorter duration of treatment with lower consumption of antibiotics is effective for treatment and can reduce the development of multiple drug resistance bacteria. Ceftazidime-avibactam, piperacillin-tazobactam and tazobactam-ceftolozane can be used as alternatives to carbapenem to treat ESBL-producing Escherichia coli. Besides that, meropenem-vaborbactam, piperacillin-tazobactam and tazobactam-ceftolozane have high cure rates in treating complicated UTI and pyelonephritis

Research conclusions

Novel antibiotics and combination antibiotic therapy regimens are effective in managing complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.

Research perspectives

Further research is needed to compare the efficacy of different antibiotic therapies and identify the spectrum of patients in whom different antibiotics offer better clinical outcomes and prognosis.