Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: Retrospective cohort study

Abstract

Clinical guidelines recommend at least 7days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations. This retrospective cohort study included men aged greater than or equal to 65years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7days in a propensity-score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death. Of 360640 men aged greater than or equal to 65years, 33745 (9.4%) had a UTI. Compared with 7days, men prescribed 3-day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25-1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45-0.97). We estimated that treating 150 older men with 3days instead of 7days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million. Antibiotic treatment for older men with suspected UTI could be reduced to 3days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed.