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.
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