Longer antibiotic treatment associated with more recurrence of male UTIs

Antibiotic treatment longer than a week was associated with worse outcomes for men with urinary tract infections (UTIs) compared to shorter therapy, a new study found.

The observational study included more than 30,000 men with UTIs treated as outpatients in the Veterans Affairs system during fiscal year 2009. The most commonly used antimicrobials were ciprofloxacin (62.7% of infections) and trimethoprim-sulfamethoxazole (26.8% of infections). Most of the patients (65%) received more than seven days of antibiotics (usually 10 days), but 35% received shorter treatment (usually seven days). Results were published online by Archives of Internal Medicine on Dec. 3.

Overall, 9.9% of the index infections were followed by a late recurrence (at least 30 days later) and 4.1% had an early recurrence (less than 30 days). There was no difference in the risk of early recurrence between the shorter and longer treatment groups, but patients treated for seven days or more had an increased risk of late recurrence (10.8% vs. 8.4%; P<0.001). This difference remained significant after multivariate analysis, with an odds ratio (OR) of 1.20 (95% CI, 1.10 to 1.30). Longer treatment was also associated with higher rates of Clostridium difficile infection in the next year (0.5% vs. 0.3%), although this finding was not significant after multivariate analysis (OR, 1.42; 95% CI, 0.97 to 2.07).

The study authors acknowledged that the study was limited by its observational nature and that some unmeasured factor, such as more patients with catheters receiving longer therapy, could have confounded the results. Still, the findings raise questions about the value of longer treatment for UTIs in male outpatients, the authors said. They called for randomized trials directly comparing longer and shorter treatment for these infections.

An accompanying editorial noted that most research and guidelines on UTIs focus on female patients. Although this retrospective study doesn't establish that longer treatment causes recurrence or C. difficile infection, the findings have biologic plausibility, the editorialist wrote. “We recommend a culture shift in antibiotic prescribing practices for men with bacteriuria from ‘more is better’ to ‘less is more,’” the editorial concluded.