Abstract
Background
Urinary tract infections (UTIs) are a frequent cause of morbidity and mortality in hospitalized patients, if not adequately and promptly treated. The optimal treatment duration is controversial and most recommendations are based on clinical experience. Current guidelines recommend 5–14 days of treatment depending on the type and severity of infection and the antibiotic used. With the emergence of multi-drug resistance, shorter durations are increasingly favored. This systematic review of randomized controlled trials (RCTs) aims at providing updated evidence on the effectiveness of short (≤7 days) vs. long (>7 days) antibiotic regimens in hospitalized adult patients.
Methods
MEDLINE, EMBASE, and CENTRAL were searched to identify relevant RCTs. Trial quality was evaluated using Cochrane’s Risk of Bias Tool. The primary outcome was clinical success. Secondary outcomes included microbiological success, withdrawal due to adverse events (AE), relapse, and reinfection rates. A random-effect meta-analysis was performed using R.
Results
8 RCTs conducted between 1995 and 2018 were identified. Trial quality was considered poor in 5, fair in 1 and good in 2 RCTs. Clinical and microbiological success was reported in all studies. Withdrawal due to AE was reported in 5, relapse and reinfection in 3 studies. Overall, there was no difference in clinical success between short and long courses (OR = 0.92, 95% CI 0.66–1.29; 2111 patients) (figure). Similarly, microbiological success was comparable in the two arms (OR = 1.0, 95% CI 0.70–1.43; 2111 patients). There was a higher, but nonsignificant, number of withdrawals due to AE in the long duration arm (OR = 0.78, 95% CI 0.29–2.11; 1890 patients). Patients receiving short courses had a nonsignificant higher rate of relapse (OR = 2.65, 95% CI 0.31–22.39, 175 patients). However, there was no difference in reinfection rates (OR = 1.12, 95% CI 0.26–4.90; 175 patients). A subgroup analysis limited to complicated UTIs showed similar results.
Conclusion
Based on the limited available evidence, short antibiotic courses appear to be equally effective as longer courses in the management of inpatient UTIs. Further research is needed to determine appropriate antibiotic treatment durations and assess treatment-related development of drug resistance.
Disclosures
All authors: No reported disclosures.
The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1
