Is week long ofloxacin as effective as 2-week therapy for febrile UTI?

A new study published in the Clinical Infectious Diseases suggests that for men with febrile urinary tract infection (UTI), a 7-day course of ofloxacin was less effective than a 14-day course and should not be advised.

It's still debatable how long males should receive antibiotic therapy for urinary tract infections. As a result, Matthieu Lafaurie and colleagues carried out this research to assess the effectiveness of antibiotic therapy at various time points.

This multicenter randomised, placebo-controlled, double-blind, non-inferiority trial included 282 men from 27 centres in France to assess the effectiveness of a complete antibiotic regimen of 7 days against 14 days for the treatment of febrile urinary tract infections in men. Men qualified if they had a febrile UTI and a urine culture that revealed a single uropathogen. At day 1, the participants received either ofloxacin or a third-generation cephalosporin treatment. At days 3–4, the participants were then randomly assigned to receive either ofloxacin for the remaining 14 days of their treatment or a placebo for the first 7 days.

The primary outcome was treatment success, which was determined by a negative urine culture, the lack of a fever, and the need for any additional antibiotic treatment between the conclusion of the treatment and six weeks following day 1. Recurrent urinary tract infections and drug-related incidents were secondary outcomes that were measured between weeks 6 and 12 after day 1.

The key findings of this study were:

1) Antibiotic treatment for 7 (115 participants) or 14 days was randomly assigned to 240 participants (125 participants). 

2) In the ITT analysis, 64 people (55.7%) in the 7-day group and 97 participants (77.6%) in the 14-day group experienced treatment success; this shows inferiority (risk difference: 21.9 (-33.3 to -10.1)). 

3) Four individuals in the 7-day arm and seven participants in the 14-day arm reported adverse events during antibiotic medication. 

4) There was no difference in the rectal carriage of resistant Enterobacterales between the two groups.

According to this study's findings, treating febrile UTI in men with ofloxacin for 7 days is not as effective as treating them for 14 days.

Reference: 

Lafaurie, M., Chevret, S., Fontaine, J.-P., Mongiat-Artus, P., de Lastours, V., Escaut, L., Jaureguiberry, S., Bernard, L., Bruyere, F., Gatey, C., Abgrall, S., Ferreyra, M., Aumaitre, H., Aparicio, C., Garrait, V., Meyssonnier, V., Bourgarit-Durand, A., Chabrol, A., … Piet, E. (2023). Antimicrobial for 7 or 14 days for febrile urinary tract infection in men: a multicenter noninferiority double blind placebo-controlled, randomized clinical trial. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciad070