No advantage for longer antibiotic course in men with uncomplicated UTI

  • Germanos GJ & al.
  • Open Forum Infect Dis
  • 1 Jun 2019

  • International Clinical Digest
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Takeaway

  • Outpatient male urinary tract infection (UTI) antibiotic treatment >7 days was associated with a >2-fold increased risk for recurrence among men without complicating conditions.

Why this matters

  • Prescribe shorter (≤7 days) antibiotics for UTI in male outpatients.
  • Longer antibiotic duration does not confer any benefit for reducing early (6-29 days) or late (30-365 days) recurrence postinitial diagnosis.

Key results

  • 637 visits, 573 unique men.
  • 18.7% (119/637) visits had ≥1 complicating factors.
  • Age, Charlson comorbidity index (CCI), department (visited) significantly predicted antibiotic choice.
    • Older men ≥55 years prescribed fluoroquinolones less frequently than younger men (65.4% vs 74.6%, respectively; P=.01), more likely to receive nitrofurantoin (7.4% vs 3%; P=.01).
    • Higher CCI likely to receive beta-lactam, despite age (OR=1.43; 95% CI, 1.04-1.95).
  • Urology department visits: likelier to receive beta-lactam (OR, 6.7; 95% CI, 1.9-23.4), less likely to receive trimethoprim-sulfamethoxazole (OR=0.54; 95% CI, 0.36-0.82).
  • Complication presence (ß-coefficient, −3.076; 95% CI, −5.950 to 0.202; P=.036) significantly predicted longer treatment duration.
  • Longer treatment duration associated with increased recurrence after excluding urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, benign prostatic hyperplasia (n=331; OR=2.62; 95% CI, 1.04-6.61).

Study design

  • Retrospective observational cohort assessing link between treatment duration, UTI recurrence in outpatient male UTI with/without complicating factors, 2011-2015.
  • Funding: US Department of Health and Human Services.

Limitations

  • Retrospective.
  • Confounder bias.
  • Misclassifications, coding bias.