Less is more when it comes to antibiotics for UTI in men

By Caroline Price, Senior medwireNews Reporter

Research suggests that standard antibiotic prescribing for urinary tract infections (UTIs) in male patients may need to be reviewed, as currently recommended 7-14-day courses appear to be no more effective than shorter ones, and may increase the risk for antimicrobial resistant or Clostridium difficile infection.

The study found that patients who received antibiotic treatment (mainly with ciprofloxacin or trimethoprim-sulfamethoxazole) for more than 7 days were no less likely to suffer a recurrence of the infection than those who took a shorter course.

Unlike in women, the optimal treatment duration for UTI in men remains ill defined.

Dimitri Drekonja and colleagues, from Minneapolis Veterans Affairs Health Care System in Minnesota, used administrative data from the Veterans Affairs Computerized Patient Record System to identify 33,336 male cases, treated for a total of 39,149 UTI episodes, for analysis.

They report in the Archives of Internal Medicine that the duration of antibiotic treatment patients received was largely within the recommended 7-14 days (84.4% of patients) but varied substantially within this range and outside of it.

Early recurrence (within 30 days) occurred at a similar rate in patients treated for 7 days or less and those treated for longer than 7 days, at 3.9% and 4.2%, respectively. This held true when the comparison was limited to the 91% of patients who received either 3-7 or 8-14 days of treatment, to eliminate bias related to very short (1-2-day) or long (>14-day) courses.

Longer duration treatment (>7 days) was actually associated with an increased rate of late recurrence (beyond 30 days), at 10.8% compared with 8.4% for shorter treatment.

Multivariate analysis confirmed that there was no difference in the chance of early recurrence with long versus short treatment duration, while the odds for late recurrence was increased 1.2-fold with the longer course.

Longer courses were also associated with a higher rate of C. difficile infection, although this was not statistically significant on multivariate analysis. Nevertheless, the authors point out that prolonged antibiotic use increases costs, and is known to be more likely to promote colonization and infection with antimicrobial-resistant microorganisms - a particular concern in UTIs as the main microorganisms involved are Gram-negative bacilli for which few effective oral antimicrobial agents are available.

Drekonja and team's findings "call into question current treatment practices concerning bacteriuria in men," writes Barbara Trautner, from the Baylor College of Medicine in Houston, Texas, in a related commentary.

"We recommend a culture shift in antibiotic prescribing practices for men with bacteriuria from 'more is better' to 'less is more.' Widespread antimicrobial resistance, appreciation of the human microbiome, outbreaks of CDI [C. difficile infection], and emphasis on cost-effective care discourage the indiscriminate use of antibiotics."

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