Shorter Antibiotic Treatment Still Effective in Male Veterans With UTI

There were no significant differences in outcomes for 7-day and 14-day antibiotic treatment in male veterans with urinary tract infection (UTI), suggesting that a shorter course of antibiotics is noninferior for this patient population, according to new research published in JAMA.¹

Researchers conducted a randomized clinical trial with 272 afebrile men, median age of 69 years, at two Veterans Affairs (VA) medical centers. Inclusion criteria were at least 1 symptom of UTI and diagnosis by their treating clinician.

All participants received antibiotic therapy for 7 days (either ciprofloxacin or trimethoprim/sulfamethoxazole), and one group continued therapy for another 7 days while the other was switched to placebo.

Patient follow up was conducted at days 7, 14, and 28. The primary outcome was symptom resolution at 14 days after completion of treatment, with a noninferiority margin of 10%.

Key findings¹ indicated that:

• the primary outcome was met in 93.1% of participants that received treatment for 7 days, compared to 90.2% in the 14-day group (difference, 2.9% [1-sided 97.5% CI, -5.2% to ∞]);
• there was no significant difference in symptom recurrence within 28 days of stopping treatment, with 9.9% recurrence in the 7-day group and 12.9% in the 14-day group (difference, -2.3% [2-sided 95% CI, -10.8% to 6.2%], P=.70);
• in the 7-day group, 20.6% participants reported adverse events (predominantly diarrhea, nausea, and abnormal blood glucose readings), compared with 24.3% in the 14-day group; and
• there were no cases of progression to pyelonephritis or bacteremia in either group.

Thirteen participants in the 14-day group and 5 participants in the 7-day group did not complete their treatment course, “which may indicate patient preferences for shorter antibiotic courses,” according to an editorial² published in correlation with the study.

“For men with symptoms of lower UTI without fever or other evidence of systemic disease, 7 days of antibiotics should become a standard approach and shorter courses of therapy may be equally effective,” editorial authors concluded.

A treatment duration of 3 to 5 days has shown efficacy in women with UTI. Authors added that a treatment duration of 5 days or less may be effective for some men with UTI as well, but more research is needed to confirm this.

“Shortening this course of treatment is important in preserving the overall effectiveness of antibiotics,” said study author Barbara Trautner, MD, PhD, Houston VA infectious disease physician, in a VA press release.³

References:

1. Drekonja DM, Trautner B, Amundson C. Effect of 7 vs 14 days of antibiotic therapy on resolution of symptoms among afebrile men with urinary tract infection. JAMA. 2021;326(4):324-331. doi:10.1001/jama.2021.9899
2. Morgan DJ, Coffey KC. Shorter courses of antibiotics for urinary tract infection in men. JAMA. 2021;326(4):309-310. doi:10.1001/jama.2021.11120
3. VA clinical breakthrough study shows effective male UTI treatments in just seven days. News release. US Department of Veterans Affairs. August 3, 2021. Accessed August 5, 2021. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5700