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Longer treatment duration associated with late UTI recurrence in men
No reduction was observed in recurrence of urinary tract infections in males who received a longer duration of treatment, recent study findings concluded.
Researchers from the Minneapolis VA Health Care System conducted the study, which included 39,149 UTI-related encounters in which antimicrobial treatment was prescribed. Among 33,336 index cases, 35% received antimicrobials for 7 days or less and 65% received antimicrobials for more than 7 days. Ciprofloxacin was the most common treatment, followed by trimethoprim-sulfamethoxazole.
Among the index cases, 1,373 had a single early recurrence or multiple early recurrences. The median time to early recurrence was 14 days. In addition, 3,313 index cases had a single late recurrence or multiple late recurrences. The median time to late recurrence was 107 days. There were 237 index cases that had both early and late recurrences.
In a multivariate analysis, treatment duration was not associated with early UTI recurrence. Early recurrence was associated with incontinence, beta-lactam treatment, history of UTIs and prostate hypertrophy. Longer treatment duration was not associated with an increase in late recurrence. The same factors associated with early recurrence were also associated with late recurrence.
The researchers also evaluated the incidence of Clostridium difficile infection after treatment. Among the index cases, 144 were diagnosed with C. difficile within 90 days after treatment. In a multivariate analysis, treatment duration was not associated with C. difficile infection. Beta-lactam treatment, history of C. difficile and Charlson comorbidity index were associated with C. difficile.
“These findings question the role of longer-duration treatment for male UTI in the outpatient setting,” the researchers wrote. “A randomized trial is needed to directly assess the benefits and harms of shorter-duration vs. longer-duration treatment for male UTI.”
Disclosure: One researcher reports financial relationships with Merck, Rochester Medical and Syntiron.
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