Treatment of uncomplicated UTI in males: a systematic review of the literature

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Figure 1. PRISMA flow diagram. RCT = randomised controlled trial; UTI = urinary tract infection.

Table 1. Descriptive characteristics of studies included

Characteristics/studies	Gleckman et al³⁰	Iravani³¹	van Nieuwkoop et al²⁹
Total study duration (months)	3	Not available	3
Total sample	42	727	200
Male participants	42	38 (outcome available for 21)	38
Median patient age, years	63	53 and 45	64
Indication	Recurrent UTI	Uncomplicated UTI	Febrile UTI
Antimicrobial used	TMP-SMX (160/800 mg, twice daily)	Lomefloxacin (400 mg, once daily), norfloxacin (400 mg, twice daily)	Ciprofloxacin (500 mg, twice daily)
Comorbidities reported	Yes: diabetes (10)	No	Yes: diabetes (9) urological and heart conditions
Study setting and country	Urology outpatient clinic, US	Outpatients in medical centres, US	Primary care centres, the Netherlands

Table 2. Comparison of UTI clinical and bacteriological cure at the end of treatment, and recurrence

Studies	Antimicrobial	Dose^a	Duration	n	Clinical cure	Recurrence	Bacteriological cure
					n	%	n	%	n	%
³⁰Gleckman et al 1979	TMP-SMX+ Placebo	160/800 mg BD	14 days	21			13	62	6	29
³⁰Gleckman et al 1979	TMP-SMX	160/800 mg BD	42 days	21			6	29	13	62
³¹Iravani 1992	Lomefloxacin	400 mg QD	7–10 days	10	10	100			10	100
³¹Iravani 1992	Norfloxacin	400 mg BD	7–10 days	11	11	100			10	91
²⁹van Nieuwkoop et al 2017	Ciprofloxacin	500 mg BD	7 days	19	17	90	2	11	19	100
²⁹van Nieuwkoop et al 2017	Ciprofloxacin	500 mg BD	14 days	19	19	100	2	11	18^a	100

BD = twice a day. TMP-SMX = trimethoprim-sulfamethoxazole. QD = once a day. ^aOne missing urine sample.

Table 3. Risk of bias assessment

	Gleckman et al³⁰	Iravani³¹	van Nieuwkoop et al²⁹
Sequence g eneration	Low: table of random digits	Low	Low: randomised stratified per centre and sex. Computer-generated randomisation list
Allocation c oncealment	Unclear: no information provided	No comment	Low: treatment allocation completed after urine culture results. Restricted access to independent pharmacy
Blinding of participants and personnel for all outcomes	Unclear: no description of the blinding provided	High: no blinding of the participants or personnel only investigators	Low: double blinding
Blinding of outcome assessors for all outcomes	Unclear: no description of the blinding provided	Low: investigators were blinded through third party. The drugs were dispensed by an independent third party to ensure investigator blinding	Low: analysis based on intention to treat population
Incomplete outcome data for all outcomes	High: data not reported for two patients in each group suffering adverse events	High: the main outcome (clinical recovery) is reported for 436/727 patients only	Low
Selective outcome reporting	Low	Unclear: both outcomes assessed were reported, but no pre-published protocol is available to control this with the initial design	Unclear: all outcomes described in methods chapter are reported
Other sources of bias	Low	High: men are just 5% of population and a subgroup of the study. Dropout is about 50% for bacteriological cure and unclear for clinical cure.	None identified