Less is more: Drawbacks seen to longer antibiotic treatment

A VA database study that included more than 33,000 men found benefits to shorter, rather than longer, treatment with antibiotics for urinary tract infections. The current guidelines call for using the drugs 7 to 14 days.

Drug decisions—A VA database study that included more than 33,000 men found benefits to shorter, rather than longer, treatment with antibiotics for urinary tract infections. The current guidelines call for using the drugs 7 to 14 days. (Photo: iStock)

A VA study of more than 33,000 men found that giving antibiotics for longer than a week to treat urinary tract infections (UTIs) did nothing to improve outcomes, compared with shorter treatment. Plus, the longer regimen increased the risk of re-infection.

The researchers, from the Minneapolis VA Health Care System, reported their results Dec. 3 in the Archives of Internal Medicine.

Doctors are wary of cutting short antibiotic regimens because that may pave the way for infections to return. On the other hand, taking antibiotics for too many days can lead to other problems. It can raise the risk of side effects, add to costs, and promote resistant strains of germs.

Guidelines recommend that UTIs in men be treated with antibiotics for 7 to 14 days. Whether a two-week regimen adds benefits over a one-week regimen has been unclear.

More than 39,000 Veterans included in analysis

Dimitri Drekonja, MD, MS, and colleagues studied more than 39,000 cases of urinary tract infection in men. Most patients were treated with either ciprofloxacin or trimethoprim-sulfamethoxazole.

Compared with shorter treatment—seven days or less—longer treatment did nothing to reduce the risk of the original infection coming back. In fact, longer treatment was linked to more recurrences of the original infection. Also, patients on longer regiments were more likely to become infected with C. difficile. This tough-to-treat germ, which causes diarrhea, sometimes severe, is a major problem for U.S. hospitals. It infects up to 20 percent of inpatients. Almost all cases are linked to antibiotics. The drugs kill healthy flora in the gut that prevent C. difficile from turning into its infectious form.

Drekonja says he would now like to see a randomized clinical trial—not just a retrospective database study—to test shorter versus longer antibiotic treatment for UTIs in men.

The study was conducted through VA's Center for Epidemiological and Clinical Research and the Center for Chronic Disease Outcomes Research, both based at the Minneapolis VA.