Impact of antibiotic treatment duration on outcomes in older men with suspected urinary tract infection: Retrospective cohort study

Pharmacoepidemiol Drug Saf. 2019 Jun;28(6):857-866. doi: 10.1002/pds.4791. Epub 2019 May 2.


Purpose: Clinical guidelines recommend at least 7 days of antibiotic treatment for older men with urinary tract infection (UTI). There may be potential benefits for patients, health services, and antimicrobial stewardship if shorter antibiotic treatment resulted in similar outcomes. We aimed to determine if treatment duration could be reduced by estimating risk of adverse outcomes according to different prescription durations.

Methods: This retrospective cohort study included men aged greater than or equal to 65 years old with a suspected UTI. We compared outcomes in men prescribed 3, 5, 7, and 8 to 14 days of antibiotic treatment in a multivariable logistic regression analysis and 3 versus 7 days in a propensity-score matched analysis. Our outcomes were reconsultation and represcription (proxy for treatment failure), hospitalisation for UTI, sepsis, or acute kidney injury (AKI), and death.

Results: Of 360 640 men aged greater than or equal to 65 years, 33 745 (9.4%) had a UTI. Compared with 7 days, men prescribed 3-day treatment had greater odds of reconsultation and represcription (adjusted OR 1.48; 95% CI, 1.25-1.74) but lower odds of AKI hospitalisation (adjusted OR 0.66; 95% CI, 0.45-0.97). We estimated that treating 150 older men with 3 days instead of 7 days of antibiotics could result in four extra reconsultation and represcriptions and one less AKI hospitalisation. We estimated annual prescription cost savings at around £2.2 million.

Conclusions: Antibiotic treatment for older men with suspected UTI could be reduced to 3 days, albeit with a small increase in risk of treatment failure. A definitive randomised trial is urgently needed.

Keywords: aged; electronic health records; men; pharmacoepidemiology; primary care; urinary tract infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / epidemiology*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / therapy
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / standards
  • Anti-Bacterial Agents / therapeutic use*
  • Cost Savings
  • Drug Costs
  • Drug Prescriptions / statistics & numerical data
  • Duration of Therapy*
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medication Adherence / statistics & numerical data
  • Practice Guidelines as Topic
  • Propensity Score
  • Retrospective Studies
  • Sepsis / epidemiology*
  • Sepsis / etiology
  • Sepsis / therapy
  • Treatment Failure
  • United Kingdom / epidemiology
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / mortality


  • Anti-Bacterial Agents