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Shorter Antibiotics Durations May Be Effective for Treating Uncomplicated Cystitis

JUN 09, 2020 | JONNA LORENZ
antibioticsAcute uncomplicated cystitis in adult women may be treated effectively with shorter-term therapies with some antibiotics, according to a recent study.

Investigators with Yonsei University College of Medicine and Soonchunhyang University College of Medicine in South Korea analyzed 61 randomized clinical trials involving 20,780 patients to reappraise the treatment duration of antibiotics in current international guidelines to determine whether the durations could be reduced.

The study was published in The Lancet Infectious Diseases.

Primary outcome was complete disappearance of all baseline symptoms of acute uncomplicated cystitis, and secondary outcome was microbial response.

“Our network meta-analysis showed that single-dose third-generation and fourth-generation fluoroquinolone induced similar clinical and microbial responses to three-day regimens, and the effect of 3-day pivmecillinam was also similar to that of five-day and seven-day regimens,” investigators wrote.

More research is needed to verify whether the effects of shorter three-day regimens for nitrofurantoin and trimethoprim, and single-dose regimens for first-generation and third-generation cephalosporins also may be similar to longer recommended durations.

The study found current recommendations for three-day regimens of cotrimoxazole and second-generation fluoroquinolone to be appropriate.

“Because antibiotic resistance has been increasing substantially worldwide, a shorter treatment duration can be beneficial in minimizing antibiotic resistance and collateral damage and reducing antibiotic-related costs and adverse effects,” investigators noted. “From this point of view, our findings are thought to be valuable.”

Urinary tract infections affect 40-50% of women at least once in their lifetime, with most infections being acute complicated cystitis and Escherichia coli being the most common pathogen.

First choice antibiotics recommended to treat these infections are nitrofurantoin, fosfomycin trometamol, trimethoprim and sulfamethoxazole (cotrimoxazole), trimethoprim, and pivmecillinam.

Along with combating the emergence of antibiotic-resistant organisms, the benefits of shorter-term treatments include fewer adverse effects and lower costs.

The study is the first to compare treatment durations for antibiotics recommended for treatment of uncomplicated cystitis.

Limitations included that doses were not consistent in several studies of the same antibiotics, differences in inclusion and exclusion criteria for trials, evaluation of primary outcome was subjective with possible differences in how symptoms are described, and variability in drug resistance may have affected treatment outcomes.

Prevalence of multidrug resistant isolates among patients with urinary tract infections is increasing, according to a recent study. Risk factors include abnormalities of the genitourinary tract, prior antimicrobial use, recurrent UTIs, recent hospitalization, nursing home or long-term care facility residence, regular hemodialysis clinic visits, urologic procedures within the past 3 months, chronic conditions, and older age.

That study found that about 30% and 26% of more than 200,000 urinary E coli isolates collected from adult Veterans Affairs (VA) outpatients between 2009 and 2013 were resistant to fluoroquinolones and trimethoprim/sulfamethoxazole, respectively.

Efforts to study and improve antibiotic prescribing have been ongoing as resistance rises. For example, one recent study found that providing antimicrobial stewardship education using prescribing scorecards led to decreased inappropriate antibiotic prescriptions for respiratory infections, urinary tract infections, and skin and soft tissue infections.

The rate of inappropriate antibiotic prescriptions fell from 60% to 19% after scorecards were provided.
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