Antibiotic Treatment of Common Infections

More Evidence to Support Shorter Durations

Benjamin J. Smith; George Heriot; Kirsty Buising

Disclosures

Curr Opin Infect Dis. 2020;33(6):433-440. 

In This Article

Urinary Tract Infection

Recent studies suggest that acute, uncomplicated cystitis in females can be treated with three days of β-lactam therapy.[36] Uncomplicated cystitis is uncommon in men and there are no randomized studies that have evaluated the optimal treatment duration. However, observational data suggest limited benefit in treatment beyond seven days.[37]

A number of randomized trials have investigated the optimal treatment for acute complicated urinary tract infection (cUTI) which is typically defined as urinary tract infection with fever, with or without clinical features of pyelonephritis. A seven-day course of fluoroquinolone therapy has been previously shown to be noninferior to 14 days for the treatment of cUTI in adult females.[38] A more recent RCT from the Netherlands has affirmed these findings in women but demonstrated a statistically significant difference in clinical cure rate in men treated with seven versus 14 days.[39] A small Indian RCT has provided some evidence for short-course therapy (i.e. seven days) using aminoglycosides, either as monotherapy or part of dual therapy, in a setting with high rates of infection due to drug-resistant gram-negatives.[40] A recent French RCT attempted to investigate the role for even shorter fluoroquinolone therapy (5 versus 10 days) however was prematurely stopped because of significant loss to follow up and unexpectedly high rates of fluoroquinolone resistance.[41] There is limited evidence to support short course therapy for cUTI for other antibiotic classes.

Each of the above studies excluded pregnant females and individuals with evidence of renal abscess and therefore the results may not be generalizable to those patients.

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