Extended Treatment-dose Antibiotic Therapy vs Low-dose Prophylaxis for the Management of Recurrent Uncomplicated...

To assess treatment efficacy over 1year in women with recurrent urinary tract infection (UTI) receiving extended treatment-strength antibiotics compared to standard low-dose prophylactic antibiotic regimens.

A retrospective cohort study of adult women presenting with acute uncomplicated UTI between January 1, 2018 and October 1, 2020 meeting recurrent UTI criteria (≥2 in 6months or ≥3 in 1year). Women were offered either: (1) treatment-strength antibiotic therapy for 1month; or (2) up to 7days of treatment-strength antibiotics followed by ≥3-month of low-dose prophylactic antibiotics. We excluded those with complicated UTI. The primary outcome was one or more symptomatic, culture-proven UTIs within 12months. Multivariable logistic regression assessed differences in the primary outcome while controlling for potential confounders.

Among the 246 patients, women receiving extended treatment dose antibiotics (n=43) had a significantly lower risk of experiencing subsequent UTI within 1year when compared to those receiving standard prophylactic dosing for ≥3-month (n=203) (rate 34.9% vs 59.6%; P<.01). This significant risk reduction was maintained in logistic regression analyses while controlling for potentially confounding variables (aOR 0.42; 95% CI 0.20, 0.89).

Women treated with a 1-month course of treatment-strength antibiotics had a significantly lower risk of subsequent UTI within 12months compared to women receiving ≥3-month of prophylactic antibiotics. These retrospective data preliminarily suggest that extended treatment-strength antibiotic dosing may provide therapeutic benefit while reducing overall cumulative antibiotic dose and duration. This innovative approach warrants further evaluation in randomized trials.