For afebrile men with suspected urinary tract infection (UTI), treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for one week is just as effective as a two-week course, according to a noninferiority study.
This pragmatic randomized trial enrolled 272 afebrile men (median age, 69 years) with presumed symptomatic UTI at two U.S. Veterans Affairs medical centers. All of the men were treated with treated with ciprofloxacin or trimethoprim/sulfamethoxazole for seven days; 136 continued antibiotic therapy for an additional seven days and 137 received placebo.
According to the JAMA report, there was no significant difference in the primary outcome.
Symptoms had resolved by 14 days (primary outcome) in 122 of 131 men (93 percent) who took antibiotics for one week and 111 of 123 men (90.2 percent) who took antibiotics for two weeks – a difference, 2.9 percent, which met the noninferiority criterion.
There was also no significant difference in recurrence of UTI symptoms within 28 days of stopping study medication (9.9 percent recurrence rate in one-week group and 12.9 percent in the two-week group, a difference of 2.3 percent).
The researchers note that the study was limited to ciprofloxacin and trimethoprim/sulfamethoxazole because these agents accounted for 90 percent of treatment courses for UTI in men treated in the VA health system when the study started.
“The findings support the use of a seven-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI,” write Dr. Dimitri Drekonja, with the Minneapolis VA Health Care System, and colleagues.
The authors of a JAMA editorial say it’s possible that five days or less of antibiotics may be effective for some men with UTI, based on some post hoc data, although further studies are needed to test this duration of treatment.
“Optimal antibiotic duration is being redefined in most community-acquired infections, and data indicate that five days or less of treatment is often sufficient for recovery in many patients,” note Dr. Daniel Morgan and Dr. K. C. Coffey with the VA Maryland Healthcare System in Baltimore.
“For example, optimal treatment of typical community-acquired pneumonia and cellulitis is five days. Extensive study of UTI treatment in women has found that three- to five-day courses are effective,” they point out.
“Shorter courses of antibiotic treatment are inherently easier for patients and are preferred when clinical outcomes are noninferior compared with longer duration of treatment,” write Drs. Morgan and Coffey.
The current study, they say, “should inform guidelines and should give clinicians confidence to treat thoughtfully for the shortest effective treatment duration. Treatment for men with mild symptoms of UTI should be further investigated to determine whether still shorter courses or no antibiotics may achieve the same outcome,” they conclude.