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Butler AM, Durkin MJ, Keller MR, et al. Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection. Pharmacoepidemiol Drug Saf. 2021;30(10):1360-1370doi: 10.1002/pds.5237.
Butler, A. M., Durkin, M. J., Keller, M. R., Ma, Y., Dharnidharka, V. R., Powderly, W. G., & Olsen, M. A. (2021). Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection. Pharmacoepidemiology and drug safety, 30(10), 1360-1370. https://doi.org/10.1002/pds.5237
Butler, Anne M, et al. "Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection." Pharmacoepidemiology and drug safety vol. 30,10 (2021): 1360-1370. doi: https://doi.org/10.1002/pds.5237
Butler AM, Durkin MJ, Keller MR, Ma Y, Dharnidharka VR, Powderly WG, Olsen MA. Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection. Pharmacoepidemiol Drug Saf. 2021 Oct;30(10):1360-1370. doi: 10.1002/pds.5237. Epub 2021 Apr 13. PMID: 33783918; PMCID: PMC8419150.
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Pharmacoepidemiol Drug Saf. 2021 Oct;30(10):1360-1370. doi: 10.1002/pds.5237. Epub 2021 Apr 13.

Risk of antibiotic treatment failure in premenopausal women with uncomplicated urinary tract infection.

Pharmacoepidemiology and drug safety

Anne M Butler, Michael J Durkin, Matthew R Keller, Yinjiao Ma, Vikas R Dharnidharka, William G Powderly, Margaret A Olsen

Affiliations

  1. Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA.
  2. Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
  3. Department of Pediatrics, Division of Pediatric Nephrology, Washington University School of Medicine, St. Louis, Missouri, USA.

PMID: 33783918 PMCID: PMC8419150 DOI: 10.1002/pds.5237

Abstract

PURPOSE: Acute uncomplicated urinary tract infections (UTIs) are among the most common indications for antibiotic prescriptions in otherwise healthy women. We compared the risk of treatment failure of antibiotic regimens for outpatient treatment of UTI in real-world practice.

METHODS: We identified non-pregnant, premenopausal women diagnosed with uncomplicated, lower tract UTI and prescribed an oral antibiotic with activity against common uropathogens. We used propensity score-weighted Kaplan-Meier functions to estimate 30-day risks and risk differences (RD) for pyelonephritis and UTI-related antibiotic prescription switch.

RESULTS: Of 1 140 602 patients, the distribution of index prescriptions was 44% fluoroquinolones (non-first-line), 28% trimethoprim-sulfamethoxazole (TMP/SMX) (first-line), 24% nitrofurantoin (first-line), 3% narrow-spectrum β-lactams (non-first-line), 1% broad-spectrum β-lactams (non-first-line), and 1% amoxicillin/ampicillin (non-recommended). Compared to the risk of pyelonephritis for nitrofurantoin (0.3%), risks were higher for TMP/SMX (RD, 0.2%; 95% CI, 0.2%-0.2%) and broad-spectrum β-lactams (RD, 0.2%; 95% CI, 0.1%-0.4%). Compared to the risk of prescription switch for nitrofurantoin (12.7%), the risk was higher for TMP/SMX (RD 1.6%; 95% CI 1.3%-1.7%) but similar for broad-spectrum β-lactams (RD -0.7%; 95% CI -1.4%-0.1%) and narrow-spectrum β-lactams (RD -0.3%; 95% CI -0.8%-0.2%). Subgroup analyses suggest TMP/SMX treatment failure may be due in part to increasing uropathogen resistance over time.

CONCLUSIONS: The risk of treatment failure differed by antibiotic agent, with higher risk associated with TMP/SMX versus nitrofurantoin, and lower or similar risk associated with broad- versus narrow-spectrum β-lactams. Given serious safety warnings for fluoroquinolones, these results suggest that nitrofurantoin may be preferable as the first-line agent for outpatient treatment of uncomplicated UTI.

© 2021 John Wiley & Sons Ltd.

Keywords: administrative data; anti-bacterial agents; cohort study; comparative effectiveness; propensity score; treatment failure; urinary tract infections

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