7 days of antibiotics effective for preventing recurrent cUTI among hospitalized adults
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Another study has demonstrated that a shorter course of antibiotics may be better, this time for the treatment of complicated UTIs when antibiotics with comparable IV and oral bioavailability are administered.
“UTIs are one of the most common reasons antibiotics are prescribed. With an increasingly medically complex patient population due to advancements in health care, more and more patients with UTIs qualify as having complicated UTIs (cUTIs) as they require indwelling or intermittent catheters, have renal stones, received a renal transplant, or have a multitude of other medical conditions that make UTIs increasingly challenging to treat effectively,” Pranita D. Tamma, MD, MHS, director of the pediatric antimicrobial stewardship program and associate professor of pediatrics at Johns Hopkins University School of Medicine, told Healio.
“For patients with cUTIs who require hospitalization, the duration of antibiotic therapy needed to effectively treat their cUTI is not known,” she said.
According to Tamma, there is a growing body of evidence that each additional day of antibiotic therapy increases the risk of adverse events such as antibiotic resistance, Clostridioides difficile infections, allergic reactions and more. Tamma and colleagues aimed to identify the shortest but still effective duration of therapy to treat hospitalized patients with cUTIs.
To do so, the researchers conducted an observational study of patients aged 18 years and older at 24 U.S. hospitals, although eligibility was limited to patients with associated bacteremia. The primary outcome was recurrent infection with the same species within 30 days of completing therapy.
In total, 1,099 patients met eligibility criteria and received 7, 10 or 14 days of therapy. The study demonstrated that, overall, there was no difference in the odds of recurrent infection for the 382 (46%) patients receiving 10 days and the 452 (54%) patients receiving 14 days of therapy (adjusted OR = 0.99; 95% CI, 0.52-1.87).
They did, however, find increased odds of recurrence in 265 (37%) patients receiving 7 days vs. 452 (63%) patients receiving 14 days of treatment (aOR = 2.54; 95% CI, 1.40-4.60). When limiting the 7-day vs. 14-day analysis to the 627 patients who remained on IV beta-lactam therapy or were transitioned to highly bioavailable oral agents, the researchers found that the differences in outcomes no longer remained (aOR = 0.76; 95% CI, 0.38-1.52).
“In recent years, there have been a growing number of randomized controlled trials indicating that shorter durations of therapy than historically prescribed are sufficient for a number of infectious conditions predominantly caused by gram-negative organisms, including bloodstream infections, intra-abdominal infections, pyelonephritis, and ventilator-associated pneumonia,” Tamma said. “We are pleased to see that it may be reasonable to add cUTI to that list.”
She added that shorter durations of therapy are more convenient for the patient and may lead to earlier hospital discharges and reduced adverse events; therefore, she and colleagues are “excited by these results.”
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