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Evidence summaries

Antibiotic Duration for Lower Urinary Tract Infections in Elderly Women

Short course of antibiotics is as effective as long course in the treatment of uncomplicated symptomatic lower UTI in elderly women. Single dose antibiotic treatment may be less effective but may be better accepted by the patients than longer treatments. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 15 trials involving a total of 1 644 elderly women. 5 trials compared single dose with short-term treatment (3-6 days), 3 studies single dose with long-term treatment (7-14 days) and 6 trials short-term with long-term treatment. Only 7 trials compared the same antibiotic given for a different length of time.

There was a significant difference for persistent UTI between single dose and short-course treatment (RR 2.01, 95% CI 1.05 to 3.84) and single versus long-course treatment (RR 1.93, 95% CI 1.01 to 3.70), in the short-term (< 2 weeks post-treatment) but not at long-term follow-up or on clinical outcomes. Patients preferred single dose treatment (RR 0.73, 95% CI 0.66 to 0.88), however this was based on only one trial comparing the same antibiotic. The comparison of short (3-6 days) and longer treatments (7-14 days) did not show any significant difference. Rate of adverse drug reactions increased significantly with longer treatment durations in only one study.

A systematic review 2 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 (3-6 vs7-14 days) (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

    • Lutters M, Vogt-Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database Syst Rev 2008;(3):CD001535. [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