Short-course intravenous beta-lactams for uncomplicated cystitis in hospitalized patients

Currently, the Infectious Diseases Society of America (IDSA) Guidelines for Uncomplicated Urinary Tract Infections (UTIs) recommend a 3 to 7-day antibiotic course of oral beta-lactam agents when other recommended agents are not feasible. In recent years, studies have demonstrated efficacy in shorter courses of antimicrobial therapy for acute uncomplicated cystitis compared with longer courses, but there is limited data regarding intravenous beta-lactams for acute uncomplicated cystitis.

This single-center, retrospective, non-inferiority cohort study included adult patients admitted to University of Kentucky Albert B. Chandler Medical Center or Good Samaritan Hospital with acute uncomplicated cystitis. The primary outcome assessed was treatment failure, defined as the need for retreatment with additional antibiotic therapy within 30 days of antibiotic completion. Secondary outcomes include incidence of C. difficile infection within 30 days of antibiotic therapy, hospital readmission, and outpatient telephone encounters within 30 days of discharge. Patients were divided into the short course (those receiving three days or less of beta-lactam antibiotics and at least 1 day was IV) or the long course (those receiving four or more days of beta lactam antibiotics).

Overall, 52 patients met the criteria to be included in the final study, with 33 in the short course beta-lactam group and 19 in the long-course beta-lactam group. Failure rates between short and long course were 15.2% and 15.8% respectively (p=1.000). Ceftriaxone was the most commonly utilized antibiotic in both groups. The median total antibiotic duration between the long and short groups was 3 and 6 days respectively (p<0.001).

In hospitalized patients warranting initial IV therapy for acute uncomplicated cystitis, a 3-day total of beta-lactam therapy, with transition to oral, should be considered.