Based on the findings, Dr. Eugene A. Katchman of E. Rabin Medical Center in Petah-Tiqva, Israel and colleagues write, three-day therapy should still be used for most women with cystisis. Among women for whom bacteriological eradication is essential, they add, a seven-day course of treatment may be more appropriate; for example, women who have recurrent painful infections, those who are planning to become pregnant, or those at risk for becoming immunosuppressed.

"This decision should be taken with the patient, balancing the higher bacteriological cure rate versus the increased risk for adverse events," they state in the November issue of the American Journal of Medicine.

Most trials that have compared short- to long-term antibiotic treatment for cystitis have been small, Dr. Katchman and his team note. To investigate whether these trials may have missed real differences between the two regimens, the researchers reviewed 32 randomized, controlled trials comparing the two approaches including a total of 9,605 patients.

Both short- and long-term follow-up found no difference in rates of symptomatic failure between 3-day therapy and more prolonged treatment, Dr. Katchman and colleagues found. But women given antibiotics for five days or longer were 47% more likely to be free of bacteriuria four to ten weeks after treatment.

Adverse events were 17% less frequent in the three-day therapy group, although all side effects were minor.

Additional research is needed to pinpoint the best treatment duration for women with cystitis when bacteriological cure is essential, the researchers conclude.

Am J Med 2005;118:1196-1207

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