78 - Outcomes and adherence to institutional empiric therapy guidelines for the treatment of cystitis in ambulatory male veterans

Background: Guidelines provide primary literature demonstrating efficacy and safety of cystitis treatment in female patients, but not males. Increased antimicrobial resistance of urinary tract infection (UTI) pathogens to first line antibiotics are well-documented. In 2017, a change in institutional guidelines was made to recommend nitrofurantoin (NF) or cefpodoxime (CPD) as first line antibiotics for cystitis in males. This study aims to evaluate the efficacy of NF and CPD as first line treatment options in males with cystitis.

Methods: Single-center, retrospective chart review of male patients prescribed NF or CPD for treatment of cystitis in the outpatient setting from August 2017 to August 2018. Patients with asymptomatic bacteriuria, prostatitis or systemic signs and symptoms of UTI were excluded. Primary outcome was treatment failure, defined as requiring new emergency department (ED) or patient aligned care team (PACT) visit within 30 days after initiation of antibiotic for unresolved symptoms. Safety outcomes were based on documented adverse effects (AE) associated with antibiotic use. Chi-square was the primary statistical test for analyzing primary outcomes and other nominal variables.

Results: A total of 450 charts were reviewed with 150 patients meeting inclusion criteria (NF n = 75, CPD n = 75). Baseline characteristics were equally distributed between the two groups although the CPD group had higher serum creatinine compared to the NF group (p = 0.05). Nine patients (12%) in the NF group versus 13 patients (17.3%) in the CPD group returned to ED or PACT within 30 days (p=0.36). Inappropriate dosing was seen in 13 patients (17.3%) in the NF group vs. 2 patients (2.7%) in the CPD group (p = 0.005) and 44 patients (58.7%) in the NF group vs. 37 patients (49.3%) in the CPD group who received an inappropriate duration of treatment (p = 0.25). None of the patients reported AE associated with antibiotic use.

Conclusion: Treatment success rate of NF and CPD (88% and 82.7%, respectively) suggests that these agents might be effective first line antibiotics for cystitis in males. High rate of inappropriate long duration of treatment indicates the need for staff education and prospective audit and feedback for outpatient stewardship interventions.