Determinants of Prolonged Antibiotic Therapy in Patients with Urinary Tract Infection

Open Access

Abstract

Background: Urinary tract infection (UTI) is among the most common bacterial infections worldwide and remains a major cause of antibiotic utilization. Although shorter antibiotic courses are recommended for many patients, prolonged therapy is frequently observed, potentially contributing to antimicrobial resistance, increased healthcare costs, and adverse drug effects. Identifying factors associated with extended antibiotic duration is essential for optimizing treatment strategies and promoting antimicrobial stewardship. Aim of the study: The study aimed to determine the clinical, demographic, and antibiotic-related factors associated with prolonged antibiotic therapy among patients with urinary tract infection. Methods & Materials: This cross-sectional observational study was conducted in the Department of Pharmacology and Therapeutics in collaboration with the Department of Medicine at Mymensingh Medical College Hospital, Bangladesh, from January 2025 to December 2025. A total of 385 adult patients with clinically diagnosed UTI receiving systemic antibiotic therapy were included. Patients were categorized into standard-duration therapy (≤10 days) and prolonged therapy (>10 days) groups. Sociodemographic characteristics, clinical factors, previous UTI history, comorbidities, and antibiotic-related variables were collected. Data were analyzed using IBM SPSS Statistics version 26.0. Logistic regression analyses were performed to identify independent predictors of prolonged antibiotic therapy, with p<0.05 considered statistically significant. Results: Among 385 patients, 68 (17.66%) received prolonged antibiotic therapy. Patients receiving prolonged therapy had significantly higher mean age (57.5±19.2 vs 52.4±18.1 years, p=0.038), longer symptom duration (16.2±5.1 vs 10.8±5.4 days, p<0.001), higher prevalence of diabetes mellitus (48.53% vs 28.08%, p=0.002), and previous UTI history (39.71% vs 22.40%, p=0.005). Persistent symptoms were the most common reason for prolonged therapy (39.71%). Multivariable logistic regression demonstrated that symptom duration >14 days (aOR=4.12, 95% CI: 2.22-7.65, p<0.001), diabetes mellitus (aOR=2.01, 95% CI: 1.13-3.59, p=0.018), intravenous antibiotic therapy (aOR=2.62, 95% CI: 1.10-6.27, p=0.031), and previous UTI history (aOR=1.79, 95% CI: 1.01-3.18, p=0.046) were independent predictors of prolonged treatment. Conclusion: Prolonged antibiotic therapy in UTI patients was primarily associated with delayed symptom presentation, diabetes mellitus, recurrent infection history, and intravenous antibiotic use. Early recognition of high-risk patients and implementation of evidence-based antibiotic stewardship strategies may help optimize treatment duration, reduce unnecessary antibiotic exposure, and limit the development of antimicrobial resistance.