Infectious diseases (London, England) · 2025
Narrow-spectrum antibiotics to male patients with acute cystitis - a retrospective longitudinal study.
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Snaebjörnsson Arnljots Egill, Björk Denny, Jacobsson Gunnar, Ulleryd Peter, Gunnarsson Ronny, Åhren Christina, Sundvall Pär-Daniel
Аннотация
BACKGROUND: A transition from fluoroquinolones to narrow-spectrum antibiotics in male patients with acute cystitis could reduce antibiotic resistance but may increase the incidence of complications. This study aimed to evaluate risks with choosing narrow spectrum-antibiotics in male patients with acute cystitis for the subsequent risks for complications (secondary events).
METHODS: This was a cohort study of all male adult residents in Region Västra Götaland, Sweden followed for eight years representing 5.3 million male person years. Male patients aged ≥18 years with acute cystitis at least once from January 2012 to December 2019 (n = 38,864) were analysed with Odds Ratio (OR) and Number Needed to Harm (NNH) for using narrow-spectrum antibiotics versus broad-spectrum fluoroquinolones to cause secondary events within 30 days.
RESULTS: Participants suffered 58,402 acute cystitis and 13,300 secondary events. The mean age of participants was 67 years (SD 17, interquartile range 58-79). The risk of pyelonephritis was higher if treated with pivmecillinam (OR 1.3, p = 0.019, NNH 440) or nitrofurantoin (OR 1.6, p < 0.001, NNH 220) at the initial cystitis compared with fluoroquinolones. Non-serious secondary events, such as treatment failure or relapse/reinfection of acute cystitis, were more common if any antibiotic other than fluoroquinolones were prescribed (OR 1.5-2.4 and NNH 5.8-14).
CONCLUSIONS: Narrow-spectrum antibiotics for acute cystitis in male patients resulted in a very small increase in the incidence of pyelonephritis and a moderate increase in treatment failure or relapse/reinfection. In our opinion this does not motivate prescribing fluoroquinolones to all men with acute cystitis.
METHODS: This was a cohort study of all male adult residents in Region Västra Götaland, Sweden followed for eight years representing 5.3 million male person years. Male patients aged ≥18 years with acute cystitis at least once from January 2012 to December 2019 (n = 38,864) were analysed with Odds Ratio (OR) and Number Needed to Harm (NNH) for using narrow-spectrum antibiotics versus broad-spectrum fluoroquinolones to cause secondary events within 30 days.
RESULTS: Participants suffered 58,402 acute cystitis and 13,300 secondary events. The mean age of participants was 67 years (SD 17, interquartile range 58-79). The risk of pyelonephritis was higher if treated with pivmecillinam (OR 1.3, p = 0.019, NNH 440) or nitrofurantoin (OR 1.6, p < 0.001, NNH 220) at the initial cystitis compared with fluoroquinolones. Non-serious secondary events, such as treatment failure or relapse/reinfection of acute cystitis, were more common if any antibiotic other than fluoroquinolones were prescribed (OR 1.5-2.4 and NNH 5.8-14).
CONCLUSIONS: Narrow-spectrum antibiotics for acute cystitis in male patients resulted in a very small increase in the incidence of pyelonephritis and a moderate increase in treatment failure or relapse/reinfection. In our opinion this does not motivate prescribing fluoroquinolones to all men with acute cystitis.