A 7-day short course of antibiotics for men with a fever-free urinary tract infection

This article is from the NEJM Journal Watch Antibiotic Treatment Duration for Afebrile Men with Urinary Tract Infections.
Comment on the course of antibiotics for men with urinary tract infections.
Author: Thomas L.
Schwenk, MD 7-day treatment is as effective as 14-day treatment, recurrence The rates are similar
.

We have been working hard to shorten the course of antibiotics for patients with common infections.
Therefore, Veterans Affairs researchers recruited 272 male patients who had no fever but had one or more symptoms of urinary tract infection (UTI) (median Age, 69 years old); the most common symptoms are dysuria (67%), frequent urination (55%) and urgency (34%)
.

The patient was included in the study during the 7th outpatient treatment period (receiving ciprofloxacin or trimethoprim/sulfamethoxazole)
.

This study did not require urine culture, but approximately 90% of patients had urine culture
.

If the patient has fever or growth of microorganisms that are not sensitive to either of the above antibiotics, they are excluded from the test
.

At the end of the first 7 days of treatment, the patients were randomly divided into two groups, one group received the original antibiotic treatment for another 7 days, and the other group received a placebo for 7 days
.

In the intention-to-treat analysis and actual treatment analysis conducted on the 14th day, there was no significant difference in the rate of symptom resolution between the 14-day treatment group and the 7-day treatment group (about 92%)
.

Subgroup analysis of patients with positive (77%) or negative (23%) urine culture also showed no difference between the two courses
.

On the 28th, the recurrence rate of symptoms in the two treatment groups was similar (about 12%)
.

No patient developed febrile UTI or upper urinary tract infection, and the incidence of adverse events was similar in the two treatment groups
.

Comment on these results to support the use of a 7-day course of antibiotics for male patients with no fever but with UTI symptoms, and suggest that a shorter course of treatment can be studied
.

The remission rates after antibiotics were similar between male patients with and without positive culture results, and between male patients who met and did not meet the symptom-based inclusion criteria.
This raises questions about the overall treatment of male UTI.
But it also reflects the practice of many clinicians in the real world
.

The reviewed article Drekonja DM et al.
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 2021 Jul 27; 326:324.
(https://doi.
org/10.
1001/jama.
2021.
9899) Related reading NEJM Journal Watch (NEJM Journal Watch) is published by NEJM Group.
Internationally renowned doctors are invited to comment on important papers in the medical field to help doctors understand and use the latest developments
.

"NEJM Frontiers of Medicine" is translated several times a week, published on the app and official website, and selected 2-3 articles are published on WeChat
.

Copyright information This article was translated, written or commissioned by the "NEJM Frontiers of Medicine" jointly created by the Jiahui Medical Research and Education Group (J-Med) and the "New England Journal of Medicine" (NEJM)
.

The Chinese translation of the full text and the included diagrams are exclusively authorized by the NEJM Group
.

If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.

Unauthorized translation is an infringement, and the copyright owner reserves the right to pursue legal liabilities
.