Prolonged Antibiotic Therapy for Recurrent Urinary Tract Infections in Aged‐Care Residents: Time to Change the Dogma?

Abstract

ABSTRACTAimTo determine whether the duration of therapy and antibiotic dosage prescribed affected the recurrence rates and times between recurrent urinary tract infection (UTI) episodes among elderly women in residential aged‐care facilities.MethodA 2‐year retrospective cohort study was conducted in 6 aged‐care facilities. Eligibility criteria were females aged ≥ 60 years in residential aged‐care for at least 6 months. Poisson regression and survival frailty modelling were used to analyse the recurrence rates and times between successive UTI episodes.ResultsOf the 200 eligible subjects, 35 (18%) had 1 UTI episode and 57 (29%) had recurrent UTI episodes during the follow‐up period. The majority (72%) of the total 269 UTI episodes were either diagnosed by midstream urine culture plus dipstick analysis, or midstream urine culture only. On average, 5 antibiotics courses with a duration of 13.5 doses were prescribed. Apart from prior history of UTI and residential status, the incidence of recurrent UTI was positively associated with the duration of antibiotic treatment (adjusted RR = 1.05; 95%CI 1.02–1.09) and antibiotic courses prescribed (adjusted RR = 1.14, 95%CI 1.09–1.20). The median time between successive UTI episodes was 125 days (95%CI 90–160). Treatment duration and antibiotic exposure did not significantly affect the recurrence times.ConclusionProlonging antibiotic therapy neither reduced the incidence of recurrent UTI nor increased the time between recurrent UTI episodes. The findings do not support antibiotic treatment guidelines currently adopted in practice and suggest the need for a prospective randomised trial.