Men with a urinary tract infection (UTI) and no fever can be effectively treated with a 7-day course of antibiotics rather than a 14-day course, according to new study findings.
In a randomized trial of 272 male veterans presumed to have UTIs, symptom resolution (by day 14) occurred in 93.1% of the 7-day antibiotic group and 90.2% of the 14-day antibiotic group, meeting a criterion for noninferiority, Dimitri M. Drekonja, MD, MS, of Minneapolis Veterans Affairs Health Care System in Minneapolis, Minnesota and colleagues reported in JAMA. Recurrence of UTI symptoms within 28 days of therapy did not differ significantly between groups: 9.9% vs 12.9%, respectively. An intent-to-treat analysis yielded similar results to the “as-treated” analysis.
Patients were treated with ciprofloxacin or trimethoprim/sulfamethoxazole at 2 Veterans Affairs medical centers. A urine culture was not required to confirm UTI. Among the 145 men who did have a culture, the most common organism was Escherichia coli, Klebsiella species, Enterococcus species, and coagulase-negative staphylococci.
Adverse events, mostly diarrhea, nausea, and abnormal blood glucose readings, were reported by 21% vs 24% of the 7-day and 14-day treatment groups, respectively. No one experienced pyelonephritis or bacteremia.
“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,” Daniel J. Morgan, MD, MS, and KC Coffey, MD, MPH, of the VA Maryland Health Care System in Baltimore, Maryland, wrote in an accompanying editorial.
They also observed, “Antibiotics, such as nitrofurantoin and amoxicillin-clavulanate, now feature more centrally in recommendations for UTI, but ciprofloxacin and trimethoprim/sulfamethoxazole remain among the most-used antibiotics for UTI.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Drekonja DM, Trautner B, Amundson C, et al. Effect of 7 vs 14 days of antibiotic therapy on resolution of symptoms among afebrile men with urinary tract infection: a randomized clinical trial. JAMA. 2021;326(4):324-331. Published online July 27, 2021. doi:10.1001/jama.2021.9899
Morgan DJ, Coffey KC. Shorter courses of antibiotics for urinary tract infection in men. JAMA. 2021;326(4):309-310. Published online July 27, 2021. doi:10.1001/jama.2021.11120