Summary of findings 2. Antibiotic 1 versus antibiotic 2 for preventing repeat UTI in children.
| Antibiotic 1 versus antibiotic 2 for preventing repeat UTI in children | ||||||
| Patient or population: children with primarily normal renal tracts who have experienced at least one UTI Setting: children who have experienced a UTI in the community and are considered for preventative treatment to reduce the risk of further UTIs Intervention: one type of antibiotic Comparison: second type of antibiotic | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with antibiotic 2 | Risk with antibiotic 1 | |||||
| Recurrence of symptomatic UTI: nitrofurantoin (1) versus cotrimoxazole (2) | 218 per 1,000 | 124 per 1,000 (76 to 201) | RR 0.57 (0.35 to 0.92) (favours nitrofurantoin) | 157 (2) | ⊕⊕⊕⊝ MODERATE 1 | No events were recorded in one study, so a single study provided data on this comparison |
| Recurrence of symptomatic UTI: cotrimoxazole (1) versus cefadroxil (2) | 80 per 1,000 | 143 per 1,000 (26 to 776) | RR 1.79 (0.33 to 9.70) (favours cefadroxil) | 46 (1) | ⊕⊕⊝⊝ LOW 2 | Single study, few methodology details, not a highly relevant comparison |
| Recurrence of symptomatic UTI: cotrimoxazole (1) versus cefprozil (2) | 206 per 1,000 | 142 per 1,000 (41 to 492) | RR 0.69 (0.20 to 2.39) (favours cotrimoxazole) | 55 (1) | ⊕⊕⊕⊝ MODERATE 2 | Single study, few methodological details, not a very relevant comparison |
| Microbial resistance to prophylactic drugs: nitrofurantoin (1) versus cotrimoxazole (2) | 672 per 1,000 | 363 per 1,000 (208 to 618) | RR 0.54 (0.31 to 0.92) (favours nitrofurantoin) | 96 (2) | ⊕⊕⊕⊝ MODERATE 1 | Both studies had limited methodology reported, but were consistent in their findings |
| Adverse events: cotrimoxazole (1) versus cefprozil (2) | 88 per 1,000 | 143 per 1,000 (32 to 643) | RR 1.62 (0.36 to 7.29) | 55 (1) | ⊕⊕⊝⊝ LOW 2 | Single study, few methodology details, not a highly relevant comparison |
| Adverse events: nitrofurantoin (1) versus trimethoprim (2) | 283 per 1,000 | 618 per 1,000 (394 to 966) | RR 2.18 (1.39 to 3.41) (favours trimethoprim) | 120 (1) | ⊕⊕⊝⊝ LOW 2 | Single study, poorly reported |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; UTI: urinary tract infection | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Both studies reported their methodology very poorly and it was difficult to be certain of design issues
2 Single study, no missing data but considerable uncertainty and imprecision