News: First-line antibiotics still most effective for uncomplicated UTI, study shows

First-line antibiotics for uncomplicated urinary tract infections (UTI) remain more effective than fluoroquinolones and beta-lactams, according to a recent study published in JAMA Network Open. Participants who received first-line antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) had a 1.78% lower risk for 30-day revisits than fluoroquinolones and a 6.40% lower risk than beta-lactams, Medscape Medical News reported.

Researchers gathered data from 57,585 episodes of UTI among 49,037 female patients between 2012 and 2021 from Independence Blue Cross claims data in Philadelphia. Participants had received either first-line antibiotics (35,018 episodes), fluoroquinolones (21,140 episodes), or beta-lactams (1427 episodes). They found adverse events were comparable between treatment groups, though first-line antibiotics showed slightly lower risks for diarrhea and acute kidney injury than fluoroquinolones.

“Using a large, contemporary clinical dataset, we demonstrate that IDSA [Infectious Disease Society of America] guidelines for treatment of uncomplicated UTI remain robust in terms of both effectiveness and adverse events, despite major changes in the epidemiology of antibiotic resistance,” the study authors wrote. “Unless a patient has a history of drug resistance or intolerance or lives in a region where local rates of resistance are high, nitrofurantoin and trimethoprim-sulfamethoxazole remain the treatments of choice."

Editor’s note: To read Medscape Medical News’ coverage of this story, click here. To access the JAMA Network Open study, click here.