This retrospective cohort study assessed the effectiveness of extended treatment-dose antibiotic therapy as compared to the standard low-dose prophylactic regimens in managing recurrent uncomplicated urinary tract infections (UTIs) among peri- and post-menopausal women. A total of 246 women with recurrent UTI – defined as ≥2 episodes in 6 months or ≥ 3 in 1 year – were treated between 2018 and 2020. Of these, 43 women received a 1-month course of treatment-strength antibiotics (extended therapy), while 203 received a standard 7-day antibiotic course followed by daily low-dose prophylaxis for at least 3 months. While the baseline characteristics differed – such as higher estrogen use in the prophylaxis group and a greater proportion of single-pathogen infections in the extended therapy group – these differences were accounted for using the multivariable regression analysis. The primary outcome was the incidence of culture-confirmed symptomatic UTIs within 12 months. Only those patients who had complete follow-up were included. Over the 12 months, UTI recurred in 15/43 women (34.9%) in the extended group versus 121/203 (59.6%) in the prophylaxis group (P < 0.01). These included both the breakthrough and the posttreatment infections. Adjusted odds of recurrence were significantly lower in the extended group (adjusted odds ratio: 0.42; 95% confidence interval: 0.20–0.89). The secondary outcomes included time to recurrence, hospitalizations, and adverse events. The Kaplan–Meier analysis showed divergence in the recurrence-free survival beginning at 2 months and persisting through 12 months (log-rank P = 0.01). Hospitalizations for pyelonephritis or sepsis were fewer in the extended group (4.7% vs. 9.9%), and adverse events were comparable. Although extended therapy involved higher initial exposure (30 days), the overall antibiotic burden was lower than in the prophylaxis group (median 90 days). These findings suggest that extended treatment may be more effective and sustainable. Prospective randomized trials are warranted to validate these results and assess antimicrobial resistance, microbiome impact, and cost-effectiveness. COMMENTS This study offers valuable insights into the management of recurrent uncomplicated UTIs in peri- and post-menopausal women. The results demonstrate that the extended treatment-dose antibiotic therapy significantly reduces the UTI recurrence rates, hospitalizations, and overall antibiotic exposure compared to the standard low-dose prophylactic regimens. The reduction in the recurrence rates from 59.6% in the prophylactic group to 34.9% in the extended treatment group, coupled with a 58% lower adjusted odds of recurrence, underscores the clinical efficacy of this approach.1 By targeting intracellular bacterial colonies and quiescent intracellular reservoirs, extended therapy addresses the biological basis of persistent infections.2,3 Furthermore, the shorter cumulative antibiotic exposure (30 vs. 90 days) supports antimicrobial stewardship goals.4 Despite these strengths, the limitations of this study include its retrospective design and single-center setting, which limits generalizability. The absence of antimicrobial resistance and microbiome data presents a gap in understanding the long-term safety. The higher incidence of vaginitis (9.1% vs. 3.0%) in the extended group may affect tolerability. Economic feasibility was also not assessed in this study. Future randomized controlled trials should validate these findings and examine the resistance patterns, microbiome effects, and cost-effectiveness.5 Tailoring therapy based on patient-specific factors may further enhance the outcomes. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Muhammed Huzaifa (Tue,) studied this question.
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