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Among afebrile men with suspected urinary tract infection (UTI), a 7-day course of ciprofloxacin or trimethoprim/sulfamethoxazole was found to be noninferior to a 14-day course, according to findings from a randomized clinical trial published in JAMA.
The double-blinded, placebo-controlled noninferiority study included a total of 272 afebrile men from 2 US Veterans Affairs medical centers who were treated with ciprofloxacin or trimethoprim/sulfamethoxazole for presumed UTI. “Participants continued the antibiotic prescribed by their treating clinician for 7 days of treatment and were randomized to receive continued antibiotic therapy (n=136) or placebo (n=136) for days 8 to 14 of treatment,” the authors reported.
The primary endpoint of the study was symptom resolution by 14 days after completing antibiotic therapy and secondary endpoints included UTI symptom recurrence and/or adverse events within 28 days following discontinuation of the study medication. The study authors selected a 10% noninferiority margin.
The median age of patients included in the study was 69 years (interquartile range, 62-73). The study authors reported that 93.1% (122/131) of the patients in the 7-day treatment group experienced symptom resolution compared with 90.2% (111/123) of patients in the 14-day treatment group (difference, 2.9%; 1-sided 97.5% CI, -5.2% to ∞), which met the noninferiority criterion.
A secondary analysis, which included all patients regardless of treatment adherence, revealed similar results, with 91.9% (125/136) of patients in the 7-day treatment group experiencing symptom resolution vs 90.4% (123/136) of patients in the 14-day treatment group (difference, 1.5%; 1-sided 97.5% CI, -5.8% to ∞).
The study authors also reported that only 9.9% (13/131) of patients in the 7-day treatment group experienced recurrence of UTI symptoms compared with 12.9% (15/123) of patients in the 14-day treatment group (difference, -3.0%; 95% CI, -10.8% to 6.2%; P =.70). Adverse events were reported in 20.6% (28/136) of patients in the 7-day treatment group and 24.3% (33/136) of patients in the 14-day treatment group.
“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 authors concluded.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Drekonja DM, Trautner B, Amundson C, Kuskowski M, Johnson JR. Effect of 7 vs 14 days of antibiotic therapy on resolution of symptoms among afebrile men with urinary tract infection: A randomized clinical trial. JAMA. Published online July 27, 2021. doi: 10.1001/jama.2021.9899
