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Evidence summaries

Duration of Antibacterial Treatment for Uncomplicated Urinary Tract Infection in Women

Three days of antibiotic therapy is similar to 5-10 days in achieving symptomatic cure during uncomplicated UTI treatment, while the longer treatment appears to be more effective in obtaining bacteriological cure. Level of evidence: "A"

A three-day course of antibiotics is recommended instead of a longer course for the treatment of uncomplicated urinary tract infection in women.

The recommendation attaches a relatively high value to avoiding adverse effects of the medication and the development of antibiotic resistance.

A Cochrane review [Abstract] 1 included 32 studies with a total of 9605 subjects. For symptomatic failure rates, no difference between three-day and 5-10 day antibiotic regimen was seen short-term (RR 1.06, 95% CI 0.88 to 1.28) and long-term follow-up (RR 1.09, 95% CI 0.94 to 1.27). Comparison of the bacteriological failure rates showed that three-day therapy was less effective than 5-10 day therapy for the short-term follow-up, however this difference was observed only in the subgroup of trials that used the same antibiotic in the two treatment arms (RR 1.37, 95% CI 1.07 to 1.74, P = 0.01). This difference was more significant at long-term follow-up (RR 1.43, 95% CI 1.19 to 1.73, P = 0.0002). Adverse effects were significantly more common in the 5-10 day treatment group (RR 0.83, 95% CI 0.74 to 0.93, P = 0.0010). Results were consistent for subgroup and sensitivity analyses.

A meta-analysis 2 included 19 RCTs involving 2867 hospitalized adults and adolescents with infection (e.g. urinary tract infection, pneumonia, and intra-abdominal infection). There was no significant difference in clinical efficacy (d 1.6% , 95% CI -1.0% to 4.2%; 13 trials, n=1727), in microbiologic cure (d 1.2%, 95% CI -4.1% to 6.4%, 8 trials), short-term mortality (d 0.3%, 95% CI -1.2% to 1.8%, 8 trials), longer-term mortality (d -0.4%, 95% CI -6.3% to 5.5%, 3 trials), or recurrence (d 2.1%, 95% CI -1.2% to 5.3%, 10 trials). Heterogeneity across studies was not significant for any of the primary outcomes.

Another systematic review 3 compared the effectiveness of short and long courses of oral antibiotics for infections treated in outpatient settings. There was no difference in the clinical cure for adults treated with short or long course antibiotics for uncomplicated cystitis (3 vs 5 days or longer) in non-pregnant women (RR 1.10, 95% CI 0.96 to 1.25; 32 studies, n=9605), or elderly women (RR: 0.98, 95% CI:0.62, 1.54; 6 studies, n=431); acute pyelonephritis; acute bacterial sinusitis; or community acquired pneumonia. No adequate evidence about the effect on antibiotic resistance was found.

    References

    • Milo G, Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici L. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2005 Apr 18;(2):CD004682. [PubMed]
    • Royer S, DeMerle KM, Dickson RP et al. Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis. J Hosp Med 2018;13(5):336-342. [PubMed]
    • Dawson-Hahn EE, Mickan S, Onakpoya I et al. Short-course versus long-course oral antibiotic treatment for infections treated in outpatient settings: a review of systematic reviews. Fam Pract 2017;34(5):511-519. [PubMed]

Primary/Secondary Keywords