In the JournalsPerspective

No advantage in treating men with UTIs for more than 7 days

There is no clinical advantage in treating men with UTIs and no additional complicating conditions for longer than 7 days, according to researchers, who found that shorter treatment duration is not associated with an increased risk for recurrence.

Writing in Open Forum Infectious Diseases, George J. Germanos, MD, postdoctoral research fellow at Baylor College of Medicine, and colleagues explained that UTIs are the most common bacterial infection in the United States, with an incidence rate of up to 2.4 cases per 1,000 men aged younger than 55 years. Among men aged 85 years or older, the incidence rate is 7.7 cases per 1,000 men, approaching the rate seen among women in the same age group.

“Antimicrobial stewardship strategies encourage using narrow-spectrum antibiotics for the shortest duration required for clinical recovery. However, in a recent review on management of UTI in older men, recommendations regarding the optimal duration of treatment were hampered due to the lack of clinical trials comparing the efficacy of different regimens,” Germanos and colleagues wrote. “We currently lack robust evidence guiding treatment duration for UTI in men in the outpatient setting.”

Numerous recent studies have demonstrated the benefits of short-course antibiotic therapy. Adding to the body of literature, Germanos and colleagues conducted a retrospective cohort study that included all male patients aged 18 years or older who presented to five outpatient specialty clinics — two family medicine clinics, one general internal medicine clinic and two private urology practices — between Jan. 1, 2011, and Sept. 30, 2015. They identified cases from the electronic health records system using ICD-9-CM diagnosis codes for UTI or lower urinary tract symptoms.

The study included 637 visits for 573 patients whose mean age was 53.7 years. According to the findings, with a prescription rate of 69.7%, fluoroquinolones were the most commonly prescribed antibiotic, followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%) and beta-lactams (3.8%), although UTI recurrence was not associated with antibiotic choice, Germanos and colleagues reported.

They found that longer treatment duration was not significantly associated with UTI recurrence (OR = 1.95; 95% CI, 0.91-4.21) in the overall cohort, but was associated with increased recurrence when men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis and benign prostatic hyperplasia were excluded from the analysis (OR = 2.62; 95% CI, 1.04-6.61).

“Shorter duration of antibiotic treatment for male UTI may lead to decreased risk of antibiotic resistance, fewer adverse effects, and lower costs,” Germanos and colleagues wrote. “We are currently conducting a randomized, controlled trial of 7 vs. 14 days of antibiotics for male UTI that will bring further evidence to guide clinical practice.” – by Marley Ghizzone

Disclosures: Germanos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

There is no clinical advantage in treating men with UTIs and no additional complicating conditions for longer than 7 days, according to researchers, who found that shorter treatment duration is not associated with an increased risk for recurrence.

Writing in Open Forum Infectious Diseases, George J. Germanos, MD, postdoctoral research fellow at Baylor College of Medicine, and colleagues explained that UTIs are the most common bacterial infection in the United States, with an incidence rate of up to 2.4 cases per 1,000 men aged younger than 55 years. Among men aged 85 years or older, the incidence rate is 7.7 cases per 1,000 men, approaching the rate seen among women in the same age group.

“Antimicrobial stewardship strategies encourage using narrow-spectrum antibiotics for the shortest duration required for clinical recovery. However, in a recent review on management of UTI in older men, recommendations regarding the optimal duration of treatment were hampered due to the lack of clinical trials comparing the efficacy of different regimens,” Germanos and colleagues wrote. “We currently lack robust evidence guiding treatment duration for UTI in men in the outpatient setting.”

Numerous recent studies have demonstrated the benefits of short-course antibiotic therapy. Adding to the body of literature, Germanos and colleagues conducted a retrospective cohort study that included all male patients aged 18 years or older who presented to five outpatient specialty clinics — two family medicine clinics, one general internal medicine clinic and two private urology practices — between Jan. 1, 2011, and Sept. 30, 2015. They identified cases from the electronic health records system using ICD-9-CM diagnosis codes for UTI or lower urinary tract symptoms.

The study included 637 visits for 573 patients whose mean age was 53.7 years. According to the findings, with a prescription rate of 69.7%, fluoroquinolones were the most commonly prescribed antibiotic, followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%) and beta-lactams (3.8%), although UTI recurrence was not associated with antibiotic choice, Germanos and colleagues reported.

They found that longer treatment duration was not significantly associated with UTI recurrence (OR = 1.95; 95% CI, 0.91-4.21) in the overall cohort, but was associated with increased recurrence when men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis and benign prostatic hyperplasia were excluded from the analysis (OR = 2.62; 95% CI, 1.04-6.61).

“Shorter duration of antibiotic treatment for male UTI may lead to decreased risk of antibiotic resistance, fewer adverse effects, and lower costs,” Germanos and colleagues wrote. “We are currently conducting a randomized, controlled trial of 7 vs. 14 days of antibiotics for male UTI that will bring further evidence to guide clinical practice.” – by Marley Ghizzone

Disclosures: Germanos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Brad Spellberg

    Brad Spellberg

    Historically, physicians have tended to treat UTIs in men for longer periods of time than infections in women. The take-home message here is that just as for complicated UTIs in women, there is no advantage to treating complicated UTIs in men for more than 7 days.

    It would be interesting to know if treatment for such infections can be even shorter. Trials for complicated UTIs primarily enrolling women have found that 5 days is also effective. One wonders if 4 to 5 days of therapy would be sufficient for men.

    In general, this is further evidence of the now overwhelmingly demonstrated concept that we treat bacterial infections for far too long. The antibiotic mantra we should all be chanting at this point is “shorter is better.”

    • Brad Spellberg, MD
    • Chief medical officer,
      Los Angeles County-University of Southern California Medical Center
      Professor of clinical medicine and associate dean for clinical affairs,
      USC Keck School of Medicine

    Disclosures: Spellberg reports consulting for Alexion, Acurx, Merck, Paratek, Shionogi and TheoremDx, and reports owning equity in BioAIM, ExBaq, Motif and Mycomed.