Antibiotic switch after treatment with UTI antibiotics in male patients

Abstract

Background: There is a lack of evidence on treatment of urinary tract infections (UTIs) in male patients in a primary care setting, and whether narrow-spectrum antibiotics are safe and effective.

Objectives: To explore antibiotic switch rates after treatment with UTI antibiotics in men over the last 11 years.

Material: We analysed data from the Norwegian Prescription Database (NorPD). Men ≥16 years receiving cefalexin, ciprofloxacin, cotrimoxazole, nitrofurantoin, ofloxacin, pivmecillinam or trimethoprim during the period 2008–2018 were included. Antibiotic switch was defined as being prescribed a different antibiotic drug appropriate for UTI within 14 days after initial treatment. We calculated rates of antibiotic switch and corresponding odds ratios for each antibiotic drug.

Results: Seven hundred twenty-six thousand and ninety-six (726,096) prescriptions to 429,807 men were defined as possible UTI episodes. Fluoroquinolones, pivmecillinam and cotrimoxazole were most frequently prescribed. Forty-nine thousand five hundred and thirty-one (49,531) (6.8%) of the treatments resulted in antibiotic switch. Compared to cotrimoxazole, the risk of antibiotic switch was higher for pivmecillinam (OR: 2.46; 95% CI, 2.39–2.53) and trimethoprim (OR: 2.12; 95% CI, 2.04–2.20), and lower for fluoroquinolones (OR: 0.40; 95% CI, 0.39–0.42) and cefalexin (OR: 0.28; 95% CI, 0.26–0.30). Treatment duration of ≥7 days and age of ≥50 years were associated with an increased risk of antibiotic switch.

Conclusion: Fluoroquinolones and cefalexin were associated with lower antibiotic switch rates than the recommended UTI antibiotics (pivmecillinam, nitrofurantoin and trimethoprim). However, the rates of antibiotic switch following treatment of male patients with first-line empirical UTI antibiotics are relatively low, indicating that the current guidelines are safe.