Narrow-spectrum antibiotics to male patients with acute cystitis - a retrospective longitudinal study

A transition from fluoroquinolones to narrow-spectrum antibiotics in male patients with acute cystitis could reduce antibiotic resistance but may increase the incidence of complications. This study aimed to evaluate risks with choosing narrow spectrum-antibiotics in male patients with acute cystitis for the subsequent risks for complications (secondary events).

This was a cohort study of all male adult residents in Region Västra Götaland, Sweden followed for eight years representing 5.3 million male person years. Male patients aged ≥18 years with acute cystitis at least once from January 2012 to December 2019 (n = 38,864) were analysed with Odds Ratio (OR) and Number Needed to Harm (NNH) for using narrow-spectrum antibiotics versus broad-spectrum fluoroquinolones to cause secondary events within 30 days.

Participants suffered 58,402 acute cystitis and 13,300 secondary events. The mean age of participants was 67 years (SD 17, interquartile range 58-79). The risk of pyelonephritis was higher if treated with pivmecillinam (OR 1.3, p = 0.019, NNH 440) or nitrofurantoin (OR 1.6, p < 0.001, NNH 220) at the initial cystitis compared with fluoroquinolones. Non-serious secondary events, such as treatment failure or relapse/reinfection of acute cystitis, were more common if any antibiotic other than fluoroquinolones were prescribed (OR 1.5-2.4 and NNH 5.8-14).

Narrow-spectrum antibiotics for acute cystitis in male patients resulted in a very small increase in the incidence of pyelonephritis and a moderate increase in treatment failure or relapse/reinfection. In our opinion this does not motivate prescribing fluoroquinolones to all men with acute cystitis.