What question did this study set out to answer?

To compare the effectiveness of different oral antibiotics for treating uncomplicated urinary tract infections in male outpatients.

March 28, 2026Open Access

Comparative effectiveness of oral antibiotics to treat uncomplicated urinary tract infections in male outpatients

Key Points

To compare the effectiveness of different oral antibiotics for treating uncomplicated urinary tract infections in male outpatients.
Retrospective cohort study of adult male outpatients diagnosed with uncomplicated UTIs from 2019-2021.
Inclusion criteria included UTI diagnosis and antibiotic prescription; exclusions were made for certain other conditions.
Overlap weighting propensity scores and generalized estimating equations were used to analyze data regarding return visits and hospitalizations.
Of 45,442 males, 12% had UTI-related return visits and 3.1% were hospitalized.
Relative risk of return visits was higher for β-lactams (1.22) and nitrofurantoin (1.47) compared to fluoroquinolones.
Nitrofurantoin was associated with lower UTI-related hospitalizations (0.60) compared to fluoroquinolones.

Abstract

Aim: New IDSA guidelines define uncomplicated UTI (uUTI) as infection limited to the bladder in both men and women. This study compared the effectiveness of β-lactams, nitrofurantoin and trimethoprim/sulfamethoxazole (TMP/SMX) to fluoroquinolones for outpatient uUTI treatment in men. Materials & methods: A retrospective cohort of adult male outpatients diagnosed with uUTI during 2019-2021 in the Department of Veterans Affairs system was created. Inclusion required an Emergency Department, Urgent/Primary Care visit with ICD-10 documentation of UTI and a prescription of interest dispensed. Patients with recent UTI, hospitalization, infectious co-diagnosis, temperature >99.9 F, pyelonephritis or prostatitis, or for whom asymptomatic bacteriuria treatment was appropriate were excluded. Overlap weighting propensity scores and generalized estimating equation models assessed the relative risk of a subsequent UTI-related visit or hospitalization within 3-30 days with a new antibiotic dispensed. Results: A total of 45,442 males (mean SD) age 71.6 (12.7) years were treated at 130 VA medical centers. Treatment n (%) included: β-lactams 17,655 (38.9%), nitrofurantoin 8394 (18.5%), TMP/SMX 9709 (21.4%) and fluoroquinolones 9684 (21.3%). UTI-related return visits occurred in 5453 (12.0%) and UTI-related hospitalization occurred in 1431 (3.1%). The adjusted relative risk (aRR, 95% CI) of a return visit compared with fluoroquinolones was higher for β-lactams (1.22, 1.02, 1.48) and nitrofurantoin (1.47, 1.23, 1.74) but not for TMP/SMX (0.99, 0.80, 1.23). The aRR for UTI-related hospitalization was not different for β-lactams (1.06, 0.80, 1.40 or TMP/SMX 0.80, [0.56, 1.15, but was lower for nitrofurantoin 0.60, [0.41, 0.89). Conclusion: Compared with fluoroquinolones, β-lactam and nitrofurantoin prescribed for outpatient uUTI were associated with modestly increased UTI-related return visits but not hospitalization in men.

Comparative effectiveness of oral antibiotics to treat uncomplicated urinary tract infections in male outpatients

Key Points

Abstract

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