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Most research to examine length of antibiotic treatment for uncomplicated urinary tract infections (UTIs) has been conducted in women, for whom clinical guidelines are well established. In a retrospective study of 33,336 veterans with uncomplicated UTIs (all outpatients; mean age, 68; median antibiotic-therapy duration, 10 days), researchers explored whether length of antibiotic therapy was associated with recurrence in men. Most patients received ciprofloxacin or trimethoprim-sulfamethoxazole; about one third were treated for ≤7 days, and the rest were treated for >7 days.
Researchers found 1373 cases of early recurrence (at ≤30 days; 4% of the cohort) and 3313 cases of late recurrence (at >30 days; 10%). In multivariate analyses, no difference was noted in risk for early recurrence between men who received longer- or shorter-duration initial treatment; risk for late recurrence was significantly higher among those who received longer-duration treatment than among those who received shorter initial courses (11% vs. 8%).
Drekonja DM et al. Urinary tract infection in male veterans: Treatment patterns and outcomes. JAMA Intern Med 2013 Jan 14; 173:62. (http://dx.doi.org/10.1001/2013.jamainternmed.829)
Trautner BW. New perspectives on urinary tract infection in men. JAMA Intern Med 2013 Jan 14; 173:68. (http://dx.doi.org/10.1001/jamainternmed.2013.1783)
Comment
This retrospective study involved an administrative database that could not capture fully the many factors that influence clinical decision making and that also might be associated with recurrence (i.e., catheter use). However, this study does suggest that the same clinical trials that were conducted in women would be justified in men to develop more precise guidelines on length of treatment.