A Seven-Day Course of Trimethoprim-Sulfamethoxazole May Be as Effective as a Seven-Day Course of Ciprofloxacin for the Treatment of Pyelonephritis

• Published in: The American journal of medicine Vol. 130; no. 7; pp. 842 - 845
• Main Authors: Fox, Miriam T, Melia, Michael T., MD, Same, Rebecca G., MD, Conley, Anna T., BA, Tamma, Pranita D., MD, MHS
• Format: Journal Article
• Language: English
• Published: 16.02.2017
• Subjects: Internal Medicine; infection; UTI; urine; antibiotics; E. coli
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2017.01.025

Abstract Introduction The Infectious Diseases Society of America guidelines recommend either 14 days of trimethoprim-sulfamethoxazole (TMP-SMX) or 7 days of ciprofloxacin for the treatment of pyelonephritis. Antibiotic courses of 7 days of TMP-SMX versus 7 days of ciprofloxacin for pyelonephritis have not been previously compared. We evaluated the odds of a subsequent, symptomatic urinary tract infection (UTI) for women with E. coli pyelonephritis receiving a 7-day course of TMP-SMX versus a 7-day course of ciprofloxacin. Methods Women ages 16 and older with Escherichia coli pyelonephritis presenting to 5 healthcare facilities in the greater Maryland area between 2010 and 2016 receiving either TMP-SMX or ciprofloxacin were included. Patients were excluded if they met any of the following criteria: (a) pregnancy, (b) dialysis dependency, (c) E. coli not susceptible to the treatment prescribed, (d) polymicrobial urine culture, or (e) greater than 48 hours of antibiotic therapy other than TMP-SMX or ciprofloxacin. Results Of 272 women meeting eligibility criteria, 81 (30%) and 191 (70%) received 7 days of TMP-SMX and 7 days of ciprofloxacin, respectively. In an adjusted model, the likelihood of a recurrent UTI within 30 days for the TMP-SMX and ciprofloxacin groups was similar (aOR: 2.30, 95% confidence interval: 0.72-7.42). Conclusions Our findings suggest that 7 days of TMP-SMX therapy may result in similar clinical outcomes compared with 7 days of ciprofloxacin for the treatment of pyelonephritis. Considering the frequency of pyelonephritis and risks of antibiotic resistance and associated toxicities, decreasing the duration of antibiotic therapy for pyelonephritis may impact a large number of women.