Longer treatment for male UTI not associated with reduced early or late recurrence risk
A study of more than 33,000 outpatient male veterans suggests that a longer duration of antimicrobial treatment of more than seven days for a urinary tract infection (UTI) appeared not to be associated with a reduced risk of early or late recurrence compared to a shorter duration (seven days or less) of treatment, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.
The optimal treatment duration for UTI in ambulatory, noncatheterized women is well defined, but the optimal treatment duration in men is unknown. Duration of antimicrobial treatment is important because an insufficient treatment duration can lead to recurrent disease, but prolonged treatment can increase costs, promote antimicrobrial resistance and increase the risk of Clostridium difficile infection (CDI, which can be contracted after prolonged use of antibiotics), according to the study background.
Dimitri M. Drekonja, M.D., M.S., and colleagues with the Minneapolis Veterans Affairs Health Care System, Minnesota, used administrative data from the Veterans Affairs Computerized Patient Record System to evaluate treatment patterns for male UTI among outpatients and to assess the association between treatment duration and outcomes, including UTI recurrence and CDI.
Researchers identified 39,149 UTI episodes involving 33,336 unique patients, including 33,336 index cases (85.2 percent), 1,772 early recurrences (4.5 percent) and 4,041 late recurrences (10.3 percent), according to the study results. Patients had an average age of 68 years.
"We found that two drugs (ciprofloxacin and trimethoprim-sulfamethoxazole) were used to treat most male UTI episodes and that the treatment duration varied substantially within the recommended seven to 14 days (84.4 percent of patients) and outside of this range (15.6 percent of patients). Most important, compared with shorter-duration treatment (≤7 days), longer-duration treatment (>7 days) exhibited no association with a reduced risk for early or late recurrence," the authors comment.
Of the index UTI cases, 4.1 percent were followed by early recurrence and 9.9 percent by late recurrence. While longer-duration of treatment was not associated with a reduction in early or late recurrence, it was associated with increased late recurrence compared with shorter-duration treatment (10.8 percent vs. 8.4 percent). Also, C difficile infection risk was higher with longer-duration vs. shorter-duration treatment (0.5 percent vs. 0.3 percent), according to the study results.
Researchers suggest their findings "question the role" of longer-duration treatment for male UTI in the outpatient setting.
"A randomized trial is needed to directly assess the benefits and harms of shorter-duration vs. longer-duration treatment for male UTI," the authors conclude.
In a related research letter, Dimitri M. Drekonja, M.D., M.S., of the Minneapolis Veterans Affairs Health Care System, Minnesota, and colleagues suggest that preoperative cultures (UCs) of urine are ordered inconsistently and that treatment of preoperative bacteriuria appears to be associated with no benefit, based on a review of medical records for patients undergoing 1,934 cardiothoracic, orthopedic and vascular procedures (Online First).
In an accompanying commentary, Barbara W. Trautner, M.D., Ph.D., of the Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, writes: "Most studies on the treatment of acute urinary tract infection (UTI) in outpatients have been performed in women, usually premenopausal women."
"What both studies can do, and indeed do effectively, is to call into question current treatment practices concerning bacteriuria in men," Trautner continues. "We recommend a culture shift in antibiotic prescribing practices for men with bacteriuria from 'more is better' to 'less is more.' Widespread antimicrobial resistance, appreciation of the human microbiome, outbreaks of CDI [Clostridium difficile infection], and emphasis on cost-effective care discourage the indiscriminate use of antibiotics."
"On the other hand, the studies commented on herein encourage more judicious use of antibiotics by failing to find evidence of clinical benefit with longer courses of antibiotics or with additional courses of preoperative antibiotics. As we continue to explore UTI in the male half of the population, these articles are a timely reminder that standard practice is not always best practice and that critical thinking is required to recognize the difference," Trautner concludes.
More information: Arch Intern Med. Published online December 3, 2012. doi:10.1001/2013/jamainternmed.829
Arch Intern Med. Published online December 3, 2012. doi:10.1001/2013/jamainternmed.834
Arch Intern Med. Published online December 3, 2012. doi:10.1001/.jamainternmed.2013.1783
Journal reference: JAMA Internal Medicine
Provided by JAMA and Archives Journals
- Malodorous urine often reported for infants with UTI Apr 02, 2012 | not rated yet | 0
- Antimicrobial resistance for common urinary tract infections drug increases five fold since 2000 Apr 30, 2012 | not rated yet | 0
- A new treatment option for Clostridium difficile: Fecal transplantation Mar 14, 2012 | not rated yet | 0
- Treatment with bisphosphonates associated with increased risk of atypical femoral fractures May 21, 2012 | not rated yet | 0
- Study identifies women at risk for urinary tract infections after pelvic-floor surgery Oct 09, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(AP)—Government health officials are investigating several health problems reported with potentially contaminated medications made by a Tennessee specialty pharmacy.
Diseases, Conditions, Syndromes 12 hours ago | not rated yet | 0
(HealthDay)—Comorbid conditions often accompany alopecia areata, according to a study published online May 22 in JAMA Dermatology.
Diseases, Conditions, Syndromes 13 hours ago | not rated yet | 0
(HealthDay)—As a world-class golfer, Stacy Lewis' accomplishments are remarkable. But it was a physical challenge in her childhood that defined her ascent to the top of her sport.
Diseases, Conditions, Syndromes 13 hours ago | not rated yet | 0
Saudi Arabia said Friday it would send samples taken from animals possibly infected with a deadly SARS-like virus to the United States for testing in a bid to find the source of disease.
Diseases, Conditions, Syndromes 17 hours ago | not rated yet | 0
The World Health Organization voiced deep concern Thursday over the SARS-like virus that has killed 22 people in less than a year, saying it might potentially spread more widely between humans.
Diseases, Conditions, Syndromes 20 hours ago | 5 / 5 (1) | 0
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
17 hours ago | 5 / 5 (3) | 0 |
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
12 hours ago | 3 / 5 (2) | 0 |
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
14 hours ago | 3.7 / 5 (3) | 0 |
Biological processes are generally based on events at the molecular and cellular level. To understand what happens in the course of infections, diseases or normal bodily functions, scientists would need to ...
15 hours ago | 5 / 5 (4) | 0 |
How can healthy people who hear voices help schizophrenics? Finding the answer for this is at the centre of research conducted at the University of Bergen.
17 hours ago | 4 / 5 (2) | 2
(Medical Xpress)—The way Alzheimer's disease is portrayed by advocacy groups and the media is having undue influence on the euthanasia debate, according to a Deakin University nursing ethics professor.
19 hours ago | not rated yet | 2