7 days antibiotic therapy better than 14 days therapy for men with UTI: JAMA
A shorter duration of antibiotic therapy is better than longer therapy for the treatment of afebrile men with suspected urinary tract infection (UTI), suggests a recent study.
USA: The study findings, published in JAMA, support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole over a 14-day course for the treatment of men with UTI. The 7-day course was found to be noninferior with regards to the resolution of UTI symptoms by 14 days after antibiotic therapy.
The widespread use of antibiotics, seen historically as miracle drugs, has some drawbacks including adverse effects and antimicrobial resistance. This has prompted reconsideration of how to best use antibiotics including limiting use by disease indication or duration. Considering this, Dimitri M. Drekonja, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, and colleagues aimed to determine whether 7 days of treatment is noninferior to 14 days when using ciprofloxacin or trimethoprim/sulfamethoxazole to treat UTI in afebrile men.
For this purpose, the researchers conducted a randomized, double-blind, placebo-controlled noninferiority trial of afebrile men with presumed symptomatic UTI treated with ciprofloxacin or trimethoprim/sulfamethoxazole. It included 1058 men, of which 272 were randomized to receive continued antibiotic therapy (n = 136) or placebo (n = 136) for days 8 to 14 of treatment. The participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment.
The prespecified primary outcome was the resolution of UTI symptoms by 14 days after completion of active antibiotic treatment.
Among 272 patients (median age, 69 years) who were randomized, 100% completed the trial and 93.4% were included in the primary as-treated analysis.
Key findings of the study include:
- Symptom resolution occurred in 93.1% participants in the 7-day group vs 90.2% in the 14-day group, meeting the noninferiority criterion.
- In the secondary as-randomized analysis, symptom resolution occurred in 91.9% participants in the 7-day group vs 90.4% in the 14-day group.
- Recurrence of UTI symptoms occurred in 9.9% participants in the 7-day group vs 12.9% in the 14-day group.
- Adverse events occurred in 20.6% participants in the 7-day group 24.3% in the 14-day group.
"Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was noninferior to 14 days of treatment with regard to the resolution of UTI symptoms by 14 days after antibiotic therapy," wrote the authors.
Reference:
The study titled, "Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial," is published in JAMA.
DOI: https://jamanetwork.com/journals/jama/article-abstract/2782300
