Extended treatment-dose antibiotic therapy bests low-dose prophylaxis for recurrent uncomplicated UTIs in postmenopausal women: Study
In a recent study, peri- and postmenopausal women with recurrent UTIs saw a 58% lower risk of recurrence with a 1-month course of treatment-strength antibiotics compared to low-dose prophylactic antibiotics over 3+ months. Among the 246 women, 34.9% of those on extended therapy experienced another UTI within a year vs. 59.6% on prophylaxis. This approach may also reduce cumulative antibiotic exposure & duration.
A study was done to assess treatment efficacy over one year in women with recurrent urinary tract infection (UTI) receiving extended treatment-strength antibiotics compared to standard low-dose prophylactic antibiotic regimens.
A retrospective cohort study of adult women presenting with acute uncomplicated UTI between January 1, 2018 and October 1, 2020 meeting recurrent UTI criteria (≥2 in 6 months or ≥3 in one year). Women were offered either: 1) treatment-strength antibiotic therapy for 1 month; or 2) up to 7 days of treatment-strength antibiotics followed by ≥3-months of low-dose prophylactic antibiotics. We excluded those with complicated UTI.
The primary outcome was one or more symptomatic, culture-proven UTIs within 12 months. Multivariable logistic regression assessed differences in the primary outcome while controlling for potential confounders. Results: Among the 246 patients, women receiving extended treatment dose antibiotics (n=43) had a significantly lower risk of experiencing subsequent UTI within 1 year when compared to those receiving standard prophylactic dosing for ≥3-months(n=203) (rate 34.9% vs 59.6%; P<0.01).
This significant risk reduction was maintained in logistic regression analyses while controlling for potentially confounding variables (aOR 0.42; 95% CI 0.20,0.89). Women treated with a 1-month course of treatment-strength antibiotics had a significantly lower risk of subsequent UTI within 12 months compared to women receiving ≥3-months of prophylactic antibiotics. These retrospective data preliminarily suggest that extended treatment-strength antibiotic dosing may provide therapeutic benefit while reducing overall cumulative antibiotic dose and duration. This innovative approach warrants further evaluation in randomized trials.
Douglas Luchristt, Nazema Y. Siddiqui, Yasmeen Bruton, Anthony G. Visco, Extended treatment-dose antibiotic therapy versus low-dose prophylaxis for the management of recurrent uncomplicated urinary tract infections in peri- and postmenopausal women. Urology, 2024, ISSN 0090-4295, https://doi.org/10.1016/j.urology.2024.12.029.
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