Egill Snaebjörnsson Arnljots, Denny Björk, Gunnar Jacobsson, Peter Ulleryd, Ronny Gunnarsson, Christina Åhren, Pär-Daniel Sundvall
{"title":"窄谱抗生素治疗男性急性膀胱炎的回顾性纵向研究。","authors":"Egill Snaebjörnsson Arnljots, Denny Björk, Gunnar Jacobsson, Peter Ulleryd, Ronny Gunnarsson, Christina Åhren, Pär-Daniel Sundvall","doi":"10.1080/23744235.2025.2566723","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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 (<i>n</i> = 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.</p><p><strong>Results: </strong>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, <i>p</i> = 0.019, NNH 440) or nitrofurantoin (OR 1.6, <i>p</i> < 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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"1-10"},"PeriodicalIF":2.3000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Narrow-spectrum antibiotics to male patients with acute cystitis - a retrospective longitudinal study.\",\"authors\":\"Egill Snaebjörnsson Arnljots, Denny Björk, Gunnar Jacobsson, Peter Ulleryd, Ronny Gunnarsson, Christina Åhren, Pär-Daniel Sundvall\",\"doi\":\"10.1080/23744235.2025.2566723\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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 (<i>n</i> = 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.</p><p><strong>Results: </strong>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, <i>p</i> = 0.019, NNH 440) or nitrofurantoin (OR 1.6, <i>p</i> < 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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":73372,\"journal\":{\"name\":\"Infectious diseases (London, England)\",\"volume\":\" \",\"pages\":\"1-10\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infectious diseases (London, England)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1080/23744235.2025.2566723\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious diseases (London, England)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1080/23744235.2025.2566723","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Narrow-spectrum antibiotics to male patients with acute cystitis - a retrospective longitudinal study.
Background: 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).
Methods: 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.
Results: 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).
Conclusions: 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.