Minneapolis, MN—Urinary tract infection is one of the diagnoses for which antibiotics are most commonly used. So, a study determining that shorter duration treatment works as well as a longer course of antibiotics can have an outsized effect on reducing overuse of antimicrobials.

That is especially the case for agents active against gram-negative bacteria, where emerging resistance is of great concern, according to a new veterans’ study.

A report in JAMA raised the question of whether men with symptoms of urinary-tract infection (UTI) who are afebrile could be adequately treated with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days, instead of the usual 14 days prescribed to resolve UTI symptoms.

Researchers from the Minneapolis Veterans’ Affairs (VA) Health Care System and the University of Minnesota and colleagues conducted a randomized clinical trial including 272 men with presumed symptomatic UTI to provide an answer. Results indicated that resolution of initial UTI symptoms by 14 days after completion of antibiotic therapy occurred in 122 of 131 (93.1%) of participants in the 7-day group and 111 of 123 (90.2%) in the 14-day group. That difference met the prespecified noninferiority margin of 10%, according to the authors.

The authors advised that their findings support the use of a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as a substitute for a 14-day course for the treatment of afebrile men with suspected UTI.

“Determination of optimal treatment durations for common infectious diseases is an important strategy to preserve antibiotic effectiveness,” they emphasized.

The randomized, double-blind, placebo-controlled noninferiority trial, reported in JAMA, was conducted at two VA facilities, with enrollment from April 2014 through December 2019 and final follow-up on January 28, 2020. Of 1,058 eligible veterans, 272 were randomized as trial participants.

For the study, patients were instructed to continue the antibiotic prescribed by their treating clinician for 7 days, and then half were randomized to receive continued antibiotic therapy—the other half got a placebo—for days 8 to 14 of treatment.

The authors noted that recurrence of UTI symptoms occurred in fewer than 10% of participants in the 7-day group versus 12.9% in the 14-day group (difference, –3.0% [95% CI, –10.8% to 6.2%]; P = .70), while adverse event rates were lower in the 7-day group, 20.6%, vs. the 14-day group, 24.3%.

“Among afebrile men with suspected UTI, treatment with ciprofloxacin or trimethoprim/sulfamethoxazole for 7 days was non-inferior to 14 days of treatment with regard to resolution of UTI symptoms by 14 days after antibiotic therapy,” the researchers concluded. “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 study was especially important, the authors wrote, because “determining the optimal treatment duration for common infectious diseases is an important strategy to preserve the effectiveness of antimicrobials. A growing body of evidence has shown that shorter-duration treatment performed similarly to longer-duration treatment for many infections, including pneumonia, intra-abdominal infections, osteomyelitis, cellulitis, urinary tract infection (UTI) in women and others. These findings support prescribing antimicrobials for no longer than needed to resolve manifestations of infection, given that extended treatment often does not provide additional benefit, is costly and inconvenient, and increases the risk of adverse events.”

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