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.
Reference:
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.
(https://www.sciencedirect.com/science/article/pii/S0090429524012184)
Keywords:
Extended, treatment-dose, antibiotic therapy, versus, low-dose, prophylaxis, management, recurrent, uncomplicated, urinary tract, infections, peri- and postmenopausal women, Douglas Luchristt, Nazema Y. Siddiqui, Yasmeen Bruton, Anthony G. Visco
