Alternative antibiotics to nitrofurantoin for treating suspected urinary tract infection in older patients were associated with lower odds of treatment failure but did not reduce the risk for UTI-related hospitalization or death, according to research published in Open Forum Infectious Diseases.
“UTI is the most common indication for antibiotic prescribing in older adults presenting to ambulatory care services and those in long-term care facilities,” researchers in the United Kingdom wrote. “Around 60% to 75% of adults presenting with suspected UTI receive empirical antibiotic therapy at the same consultation, without knowledge of microbiological susceptibilities.”
They noted that nitrofurantoin is recommended for empirical treatment of uncomplicated UTI in the U.K. and the United States, but “primary care clinicians may prescribe alternative antibiotics to improve prognosis in older, sicker patients.”
The researchers studied whether prescribing the alternative antibiotics would be associated with a reduced risk for adverse outcomes in older patients. They included patients aged 65 years or older who were empirically treated for UTI with nitrofurantoin, cefalexin, ciprofloxacin or co-amoxiclav. They matched patients on the propensity to receive a prescription for nitrofurantoin and estimated ORs for re-consultation and re-prescription — which are proxies for treatment failure, they said — hospitalization for UTI, sepsis, acute kidney injury, and death.
The researchers identified 42,298 patients aged at least 65 years who were prescribed empirical nitrofurantoin, cefalexin, ciprofloxacin or co-amoxiclav for treating UTI. Nitrofurantoin was the most commonly prescribed antibiotic and accounted for 60% of all prescriptions, with the other three drugs each accounting for less than 20% of prescriptions.
Patients who were prescribed cefalexin, ciprofloxacin or co-amoxiclav had lower odds of re-consultation or re-prescription compared with patients who were prescribed nitrofurantoin (OR for cefalexin = 0.85; OR for ciprofloxacin = 0.48; OR for co-amoxiclav = 0.77). The researchers reported greater odds of sepsis-related hospitalization among patients prescribed cefalexin (OR = 1.89) or ciprofloxacin (OR = 3.21). Patients who were prescribed cefalexin also experienced greater odds of death (OR = 1.44), the researchers reported.
“Our findings highlight the challenges associated with selecting antibiotics for older patients with suspected UTI,” the researchers wrote. “Compared to nitrofurantoin, we found no evidence that cefalexin, ciprofloxacin or co-amoxiclav prescribing was associated with a reduced risk of hospitalization or death, suggesting that the perceived aim expressed by clinicians in previous qualitative work was not achieved, and thus supporting further reductions in prescribing these agents, even in frailer, sicker patients, especially given their impact on antimicrobial resistance.” – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.