Three-Day Treatment of Urinary Tract Infections

Abstract

There is little rationale to support the currently accepted 10 to 14-day treatment period for urinary tract infection. To assess the cure rate in patients given 3 days compared to the standard 10-day period of antimicrobial therapy a prospective trial was designed to test the over-all effectiveness of each treatment. Sixty patients were randomized to either penicillin-G or trimethoprim-sulfameth-oxazole for either 3 or 10 days. Urine and external vaginal cultures were done before therapy was instituted, at day 3 while on therapy and 7 days after the completion of treatment. The over-all cure rate in the short-term treatment group was 86 per cent and in the long-term treatment group it was 88 per cent. Patients receiving trimethoprim-sulfamethoxazole had a much better response to clearance of the pathogenic bacteria from the external vagina but this did not correlate with clearance of the bladder bacteriuria. Bacterial sensitivities on the external vaginal cultures suggest that in some patients 10 days of therapy actually may aid in the development of bacterial resistance noted in subsequent bladder infections. Finally, a cost-benefit analysis revealed that the use of a 3-day regimen as standard treatment for urinary tract infections would result in a savings to our patients conservatively estimated at $62,000,000 yearly.

Treatment duration for urinary tract infections in adults

“…After the introduction of the 3-day course of antibacterial therapy, numerous investigators endorsed this treatment program for women with acute bacterial cystitis (13,27,30). These researchers supported their position by publishing data indicating that the 3-day treatment course was as therapeutically effective as the more traditional 10-day therapy and that the short-duration treatment was associated with a reduced incidence of adverse drug reactions (25).…”

“…Some studies included patients with asymptomatic bacteriuria, as well as acute pyelonephritis (13). Some studies enrolled patients with bacteria resistant to the prescribed drug treatment (27).…”

Low-Cost Medical Practices

“…For example, in 1977, nearly seven and one-half million prescriptions were written for patients, predominantly women, with urinary tract infections (85). This is the second most common infection (after upper respiratory tract) and accounts for approximately 1 % of all ambulatory visits in the United States (86).…”

“…Twenty years ago, studies suggested that outcomes were essentially the same with one to two weeks of antimicrobial treatment as with six weeks (87). More recently, several studies found virtually equivalent rates of cure (ranging from 81 to 88%) with three-day and ten-day regimens in patients with clinical symptoms of lower urinary tract infection (85,88). The shorter course had less morbidity and could yield a projected savings in the United States of more than $60 million annually (85).…”

“…More recently, several studies found virtually equivalent rates of cure (ranging from 81 to 88%) with three-day and ten-day regimens in patients with clinical symptoms of lower urinary tract infection (85,88). The shorter course had less morbidity and could yield a projected savings in the United States of more than $60 million annually (85). Other investigators are evaluating the penultimate in therapeutic parsimony, a single dosage of an antimicrobial.…”