Background: The optimal approach for treating outpatient
male urinary tract infections (UTI) is unclear. We studied the current
management of male UTI in private outpatient clinics, and evaluated antibiotic
choice, treatment duration, and the outcome of recurrence of UTI.
Methods: Visits for all male patients 18 years of
age and older during 2011-2015 with ICD-9 Codes for UTI or associated symptoms
were extracted from the EPIC Clarity Database of 2 family medicine, 2 urology
and 1 internal medicine clinics. For each eligible visit in which an antibiotic
was prescribed, we extracted data on the antibiotic used, the duration of
treatment, recurrent UTI episodes, as well as patient medical and surgical
history. Urologic anatomic abnormalities were an exclusion criterion (Figure
Results: 637 eligible
visits were included for 573 unique patients (mean age 53.7 (± 16.7 years)).
Fluoroquinolones (FQ) were the most commonly prescribed class of antibiotic
(69.7%), followed by trimethoprim-sulfamethoxazole (TMP-SMX) (21.2%),
nitrofurantoin (5.3%) and beta-lactams (3.8%). Use of FQ was lower in the age
group of 55 years and above than < 55 years (65.4% vs. 74.6% respectively, p
value < 0.01). Visits in the urology department were less likely to be
treated with TMP-SMX, but more likely to be treated with a beta lactam. Those
with a higher Charlson Comorbodity Index were more likely to be treated with
beta lactams. Nitrofurantoin use was higher for men 55 years of age and above
compared with those younger (7.4% and 3% respectively, P value <0.01).
Overall, the rate of recurrence was 5.6%. Recurrence was not
significantly different between longer (>7 days) and shorter (≤ 7
days) treatments. In the multiple regression analysis, predictors of longer
treatment duration included presence of complicating factors (pyelonephritis,
nephrolithiasis or prostatitis), use of nitrofurantoin or beta lactams, and
visits seen in urology. Presence of fever, diabetes, and BPH, as well as
patient race, were not associated with antibiotic choice or treatment duration.
Conclusion: Men with
UTIs are most frequently prescribed FQ. Providers choice of antibiotic was
influenced by patient age and comorbidities, while treatment duration was
influenced by presence of complicating factors.
Figure 1:Inclusion and Exclusion