Longer Antibiotic Courses for Men With UTIs Could Increase Recurrence Risk

Male patients exposed to longer durations of antibiotic treatment for urinary tract infections (UTIs) received no benefits and were more likely to experience a recurrence within 1 year compared with those who received shorter treatment, according to a recent study published in the journal Open Forum Infectious Diseases.

“I don’t think any of our findings were surprising,” corresponding author George J. Germanos, MD, a postdoctoral research fellow at Baylor College of Medicine, told Contagion®. “Our results only add to the existing evidence that over-treatment may result in unintended consequences.”

The study pointed out that antimicrobial stewardship programs encourage using narrow-spectrum antibiotics for short durations. It cited several studies that have suggested that shorter courses of antibiotics are as effective as longer courses but noted that existing research mostly focused on complicated infections.

Overuse of antibiotics has become a concern with the emergence of antimicrobial resistance. A recent study found that clinicians have a low threshold for initiating antibiotics in patients with symptoms similar to urinary tract infections who visit the emergency department.

In the Baylor retrospective cohort study, investigators examined 573 patients who received treatment for urinary tract infections in private outpatient clinics between 2011 and 2015.

A total of 32 patients (5.6%) experienced recurrence. Treatment longer than 7 days was associated with a 2-fold increase in recurrence after excluding those with complicating conditions.

“The current study expands on previous findings by focusing on men without urological anatomical abnormalities or instrumentation (such as urinary catheters), and by performing subgroup analyses of visits with prostatitis, pyelonephritis, BPH or nephrolithiasis and controlling for comorbidities,” investigators wrote. “Thus, our data support prescribing 7 days or less of antibiotic therapy for male UTI over a range of clinical presentations and at different clinic settings, including primary care and subspecialty clinics.”

The study cautioned that the results may have been affected by the patients’ conditions, with sicker patients receiving longer courses, possibly confounding the relationship between duration and recurrence.

“One of our co-authors, [Dimitri Drekonja, MD, MS], is currently conducting a randomized controlled trial. It will be interesting to see if the findings of that study show results similar to what we observed,” Germanos told Contagion®.

Nearly 70% of patients were prescribed fluoroquinolones, 21.2% received trimethoprim-sulfamethoxazole, 5.3% received nitrofurantoin, and 3.8% received beta-lactams. Antibiotic choice was not associated with recurrence, according to the study.

The study concluded that treating men with urinary tract infections with shorter antibiotic courses may decrease risk antibiotic resistance and adverse effects and lower costs.

“We are entering a new era of antimicrobial resistance that each provider is contributing to when we over treat infections,” Germanos told Contagion®. “There is a great need for continued research in antimicrobial stewardship and it is more important than ever to be mindful of our prescribing practices when treating infections.”