Among males, two weeks antibiotics course good enough for febrile UTIs with normal PSA

New research found that prostate involvement was not evidently seen in nearly one-fifth of men who had febrile urinary tract infections. The study was published in the European Journal of Internal Medicine.  

Subclinical prostatic involvement is the frequently seen complication in Febrile urinary tract infections (fUTI) in men as measured by a transient increase in serum prostate-specific-antigen (sPSA). The duration of therapy for febrile urinary tract infections in men had not been well established. As literature shows that Serum PSA could guide the duration of therapy based on prostatic involvement, Researchers conducted a study to evaluate recurrence rates in a 6-month follow-up period of 2-week versus 4-week antibiotic treatment in men with fUTI, based on prostatic involvement. An assessment of Clinical and microbiological cure rates at the end of therapy (EoT) was also done. 

An Open-label, not-controlled, prospective study was done on consecutive men diagnosed with fUTI. Based on the sPSA level, the duration of therapy was 2 weeks for patients with an sPSA level <5mg/L called short duration therapy, (SDT), or 4 weeks for PSA >5 mg/L called long duration therapy, (LDT). 

Results

• Ninety-one patients were included of which 19 (20%) received SDT.
• The median age was 56.9 years (range 23-88). Similar demographic, clinical characteristics and laboratory findings were seen in both groups.
• 9.8% of patients presented with bacteremia (Escherichia coli was isolated in 91%).
• Median PSA levels were 2.3 mg/L in the SDT group vs 23.4 mg/L in the LDT group.
• 26% of patients had achieved complete follow-up, in the 6-month visit.
• Nonsignificant differences between groups were found neither in recurrence rates after 6 months nor in clinical or microbiological cure rates at EoT. 

Due to the lack of evident prostatic involvement after febrile UTI in men, a 2-week regimen was found to be adequate in terms of clinical, microbiological cure, and recurrence rates for those patients without PSA elevation. 

Further reading: Monzón H, Gisbert L, Salvadó M, et al. Short versus long course therapy in the treatment of febrile urinary tract infections in men based on serum PSA values [published online ahead of print, 2022 Oct 21]. Eur J Intern Med. 2022;S0953-6205(22)00346-6. doi: 10.1016/j.ejim.2022.09.024