Sanjin tablet combined with antibiotics for treating patients with acute lower urinary tract infections: A meta‑analysis and GRADE evidence profile

Lyu,Jian; Xie,Yanming; Sun,Menghua; Zhang,Cheng; Wang,Lianxin

doi:10.3892/etm.2019.8252

Sanjin tablet combined with antibiotics for treating patients with acute lower urinary tract infections: A meta‑analysis and GRADE evidence profile

Authors:
- Jian Lyu
- Yanming Xie
- Menghua Sun
- Cheng Zhang
- Lianxin Wang
View Affiliations

Affiliations: Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, P.R. China
Published online on: November 27, 2019 https://doi.org/10.3892/etm.2019.8252
Pages: 683-695
Copyright: © Lyu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Numerous clinical studies have evaluated the performance of Sanjin tablets (SJTs) in the treatment of acute lower urinary tract infections (ALUTIs) in China. The present meta‑analysis aimed to determine the efficacy and safety of SJT combined with antibiotics for the treatment of patients with ALUTIs and to evaluate the quality of evidence. The Cochrane Library, PubMed, EMBASE, Web of Science, Chinese BioMedical Database, China National Knowledge Infrastructure, WanFang and VIP databases were searched for entries added between inception and December 2018 to identify relevant randomized controlled trials (RCTs). The Cochrane risk‑of‑bias tool and Consolidated Standards of Reporting Trials for Traditional Chinese Medicine were used for assessing the methodological quality and reporting quality of eligible studies, respectively. Meta‑analysis and quality of evidence assessment were performed with RevMan 5.3 and Grading of Recommendations, Assessment, Development and Evaluations (GRADE), respectively. A total of 8 RCTs comprising 790 patients with ALUTIs were included in the present meta‑analysis. The cure rate of SJTs combined with gatifloxacin tablets (GTs) was higher than that of GTs alone [relative ratio (RR)=1.30, 95% CI=1.07‑1.57, P=0.009]. The cure rate of SJTs combined with levofloxacin tablets (LTs) was higher than that of LTs alone (RR=1.13, 95% CI=1.04‑1.24, P=0.006). SJTs combined with LTs was better in improving the total effective rate than LTs alone (RR=1.11, 95% CI=1.03‑1.19, P=0.005). The recurrence rate for SJTs combined with antibiotics was lower than that associated with antibiotics alone (RR=0.35, 95% CI=0.13‑0.97, P=0.04). The bacterial clearance rate achieved with SJTs combined with antibiotics was higher than that obtained with antibiotics alone (RR=1.41, 95% CI=1.09‑1.84, P=0.009). The present meta‑analysis demonstrated that, compared with the effects of antibiotics treatment, SJTs combined with antibiotics improved the cure rate, total effective rate and bacterial clearance rate, and decreased the recurrence rate. In addition, no serious adverse reactions were observed in patients with ALUTIs. However, the GRADE quality of evidence was low. Thus, further large‑scale and rigorously designed clinical trials are required to improve the quality of evidence.

View Figures

View References

1	Foxman B: The epidemiology of urinary tract infection. Nat Rev Urol. 7:653–660. 2010. View Article : Google Scholar : PubMed/NCBI
2	Li XS, Feng Y, Zhou X, Fan CL and Wu XY: Study on clinical distribution and drug resistance of pathogenic bacteria of urinary tract infection in inpatients in a hospital. Chin J Disinfection. 36:279–281. 2019.
3	Foxman B: Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs. Dis Mon. 49:53–70. 2003. View Article : Google Scholar : PubMed/NCBI
4	Khoshnood S, Heidary M, Mirnejad R, Bahramian A, Sedighi M and Mirzaei H: Drug-resistant gram-negative uropathogens: A review. Biomed Pharmacother. 94:982–994. 2017. View Article : Google Scholar : PubMed/NCBI
5	El Bcheraoui C, Mokdad AH, Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Shirude S, Naghavi M and Murray CJL: Trends and patterns of differences in infectious disease mortality among US counties 1980–2014. JAMA. 319:1248–1260. 2018. View Article : Google Scholar : PubMed/NCBI
6	Bader MS, Loeb M and Brooks AA: An update on the management of urinary tract infections in the era of antimicrobial resistance. Postgrad Med. 129:242–458. 2017. View Article : Google Scholar : PubMed/NCBI
7	Wang SH, Gao YQ, Tan HG, et al: Standardization study and curative effect Analysis of Clinical treatment Scheme of Integrated traditional Chinese and Western Medicine in the treatment of Lower urinary tract infection. J Zhejiang Univ TCM. 37:1197–1200. 2013.
8	Peng YX, Liu XQ, Wen LL, et al: Antibacterial Activities of Five Chinese Medicines of Rhei Radiset Rhizoma and Their Chemical Constituents Against Multidrug-resistant Clinical Bacteria Isolates. Chin J Exp Trad Med Formulae. 20:103–107. 2014.(In Chinese).
9	Li DY, Hou Y, Zhang KY, et al: Research progress on mechanism of anti-drug resistance of traditional Chinese medicine. Chin Med Engineering. 25:16–19. 2017.(In Chinese).
10	Hou X and Wang LX: Research progress of Sanjin tablets. Evaluation Ana Drug Use Chin Hospitals. 16:1148–1151. 2016.
11	National Pharmacopoeia Committee: Pharmacopoeia of the People's Republic of China. China Medical Science Press; 2015
12	Wei XY and Lu XL: Research progress on pharmacological action of Jinyinggen. Trace Elements Health Res. 34:80812017.
13	Xie Y, Hu D, Zhong C, Liu KF, Fang E, Zhang YJ, Zhou C and Tian LW: Anti-inflammatory furostanol saponins from the rhizomes of Smilax china L. Steroids. 140:70–76. 2018. View Article : Google Scholar : PubMed/NCBI
14	Zhou YL, Zhao X, Hua J, et al: Studies on the Chemical constituents and Antioxidant activity of Jinshateng. Chin J TCM. 28:1392–1396. 2013.(In Chinese).
15	Lyu J, Xie YM, Gao Z, Shen JW, Deng YY, Xiang ST, Gao WX, Zeng WT, Zhang CH, Yi DH, et al: Sanjin tablets for acute uncomplicated lower urinary tract infection (syndrome of dampness-heat in the lower Jiao): Protocol for randomized, double-blind, double-dummy, parallel control of positive drug, multicenter clinical trial. Trials. 20:4462019. View Article : Google Scholar : PubMed/NCBI
16	Dong XL: Clinical efficacy and safety of Sanjin tablets combined with levofloxacin tablet in the treatment of urinary tract infection. The World's Latest Med Information Abstracts. 17:169–170. 2017.
17	Zheng HY and Hu JG: Efficacy of Sanjin tablets combined with gatifloxacin in the treatment of acute simple lower urinary tract infection. Zhejiang J Integrated Traditional Chin Western Med. 23:724–726. 2013.
18	Mao X, Yao RM, Xu YH, et al: Establishment of rat model of acute urinary tract infection and its application in efficacy evaluation of traditional Chinese medicine. Pharmacol Clinic TCM. 35:177–180. 2019.
19	Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S and Guyatt GH: GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 64:401–406. 2011. View Article : Google Scholar : PubMed/NCBI
20	Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, Atkins D, Kunz R, Brozek J, Montori V, et al: GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol. 64:1311–1316. 2011. View Article : Google Scholar : PubMed/NCBI
21	Higgins J and Green SE: Cochrane Handbook for Systematic Reviews of Interventions. version 5.1.0. The Cochrane Collaboration. 2011:https://handbook-5-1.cochrane.org/Updated. March. 2011
22	Liu H, Xie JX and Xu Z: Clinical study on treatment of Acute simple bacterial Lower urinary tract infection with combination of traditional Chinese and Western Medicine. J TCM. 32:2489–2492. 2017.
23	Lyu GR and Zhan YL: Clinical observation of Sanjin tablet combined with levofloxacin in the treatment of acute simple lower urinary tract infection. Chin Med J. 50:105–107. 2015.
24	Hu XL: Clinical analysis of Sanjin tablet combined with gatifloxacin in the treatment of acute lower urinary tract infection. Med Information. 27:659–660. 2014.
25	Wang DZ: Clinical analysis of Sanjin tablet combined with gatifloxacin in the treatment of acute lower urinary tract infection. J Med Forum. 32:164–165. 2011.
26	Tu Z and Wang T: Analysis of the efficacy of Sanjin tablet combined with ofloxacin in the treatment of acute lower urinary tract infection. China Grass-Roots Med. 18:2999–3000. 2011.
27	Qiu MS, Xu ZJ and Zhang CY: Analysis of 80 cases of female Acute Lower urinary tract infection treated by combination of traditional Chinese and Western Medicine. China Grass-Roots Med. 16:20762009.
28	Mei XF and Zhang CT: Clinical observation of Sanjin tablet in the treatment of acute simple lower urinary tract infection. J Modern Integration Traditional Chin Western Med. 26:4085–4086. 2008.
29	Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M and Altman DG: CONSORT: CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. Int J Surg. 10:28–55. 2012. View Article : Google Scholar : PubMed/NCBI
30	Pu X, Zhang LY and Zhang JH: A systematic review of Sanjin tablets in the treatment of simple urinary tract infection: A randomized controlled trial. Lishizhen Med Mat Med Res. 27:1012–1014. 2016.