Extended Treatment-dose Antibiotic Therapy vs Low-dose Prophylaxis for the Management of Recurrent Uncomplicated Urinary Tract Infections in Peri- and Post-menopausal Women

Objective

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

Methods

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 6 months or ≥3 in 1 year). Women were offered either: (1) treatment-strength antibiotic therapy for 1 month; or (2) up to 7 days 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 12 months. Multivariable logistic regression assessed differences in the primary outcome while controlling for potential confounders.

Results

Among the 246 patients, women receiving extended treatment dose antibiotics (n = 43) had a significantly lower risk of experiencing subsequent UTI within 1 year 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).

Conclusion

Women treated with a 1-month course of treatment-strength antibiotics had a significantly lower risk of subsequent UTI within 12 months 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.