A week of antibiotics resolved simple UTI in men at similar rates as longer therapy

A seven-day course of ciprofloxacin or trimethoprim/sulfamethoxazole was noninferior to 14 days of treatment for afebrile men with suspected urinary tract infections (UTIs), a study found.

Researchers conducted a randomized, double-blind noninferiority trial among 272 men at two Veterans Affairs medical centers from April 2014 to December 2019. All were afebrile and treated as outpatients, initially with seven days of ciprofloxacin or trimethoprim/sulfamethoxazole. They were then were randomized 1:1 to either continued antibiotics or placebo for days eight to 14. The primary outcome was resolution of symptoms by 14 days. The primary analysis included participants who took at least 26 of 28 doses and missed no more than two consecutive doses. A secondary analysis included all patients regardless of adherence. Results were published by JAMA on July 27.

A total of 254 patients (93.4%) were included in the primary as-treated analysis. Symptom resolution occurred in 93.1% (122 of 131) of participants in the group that received a week of antibiotics, similar to the 90.2% (111 of 123) in the 14-day group (difference, 2.9%; 1-sided 97.5% CI, –5.2% to ∞). This met the study's noninferiority criterion of 10%. Similarly, the secondary analysis showed symptom resolution in 91.9% (125 of 136) participants in the seven-day group compared to 90.4% (123 of 136) in the 14-day group (difference, 1.5%; 1-sided 97.5% CI, –5.8% to ∞). Recurring symptoms occurred in 9.9% of the seven-day group and in 12.9% of the 14-day group (difference, –3.0% [95% CI, –10.8% to 6.2%]; P=0.70). Adverse events happened in 20.6% of the seven-day group compared to 24.3% of the 14-day group.

The study authors concluded that the findings support the use of a seven-day course of ciprofloxacin or trimethoprim/sulfamethoxazole as an alternative to longer treatment for afebrile men with UTI. An accompanying editorial suggested that this become a standard approach for such patients, adding that five days or less of antibiotics may be effective for some men, according to a post hoc subgroup analysis.

“Shorter courses of antibiotic treatment are inherently easier for patients and are preferred when clinical outcomes are noninferior compared with longer duration of treatment,” the editorial stated. “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.”