Shorter course of antibiotics is effective for men with urinary tract infection

Researchers report that, for treatment of afebrile (non-feverish) men with a urinary tract infection (UTI), a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole is a non-inferior alternative to a 14-day course of treatment.

The findings were published on July 27, 2021 in JAMA/Journal of the American Medical Association.

“The findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to a 14-day course for treatment of afebrile men with UTI,” the authors concluded.

In this randomized, double-blind, placebo-controlled noninferiority trial which was conducted at 2 US Veterans Affairs medical centers, enrollment took place from April 2014 through December 2019, and final follow-up ended on January 28, 2020.

The investigators randomized 136 subjects to 14 days of antibiotic therapy and 136 subjects to 7 days of antibiotic treatment plus 7 days of placebo.

Median age was 69 years.

The primary endpoint was resolution of UTI symptoms by 14 days after completion of antibiotic treatment.

The researchers specified a treatment noninferiority margin of 10%.

Secondary outcomes included recurrence of UTI symptoms and/or adverse events within 28 days of the end of antibiotic treatment.

Among 272 subjects, 100% completed the trial and 254 (93.4%) were included in the primary analysis.

Symptoms resolved in 122 of the 131 (93.1%) evaluable subjects in the 7-day group vs 111 of the123 (90.2%) evaluable subjects in the 14-day group, which met the noninferiority criteria.

Recurrence of UTI symptoms appeared in 13/131 (9.9%) subjects in the 7-day group vs 15/123 (12.9%) in the 14-day group.

Adverse events occurred in 28/136 (20.6%) participants in the 7-day group vs 33/136 (24.3%) in the 14-day group.

In a related editorial published in the same issue of JAMA, the authors wrote, “In conclusion, the study by Drekonja and colleagues in this issue of JAMA indicates that 7 days of antibiotics was noninferior to 14 days for treatment of men with UTI, including those with significant comorbidities. Shorter courses of antibiotic treatment are inherently easier for patients and are preferred when clinical outcomes are noninferior compared with longer duration of treatment. This study 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.”