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Nitrofurantoin less effective than other antibiotics for UTI patients
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Patients with urinary tract infection who were treated with nitrofurantoin appeared to experience greater incidence of treatment failure, regardless of kidney function, according to recently published data.
“In our setting, nitrofurantoin was the most commonly prescribed antibiotic for a urinary tract infection in older women,” Amit X. Garg, MD, PhD, of the Institute for Clinical Evaluative Sciences, Toronto, said in a press release. “These patients had more treatment failures with nitrofurantoin compared with other antibiotics such as ciprofloxacin. However, this was evident regardless of a patient’s level of kidney function.”
Researchers examined the effectiveness of the antibiotics nitrofurantoin, ciprofloxacin, norfloxacin and trimethoprim-sulfamethoxazole in treating UTI. Study groups included a primary cohort of women aged older than 65 years with reduced kidney function as measured by glomerular filtration rate (n = 9,223), and a second group of demographically similar women (n = 182,634) with relatively high filtration rates. Cohort entries ranged from June 2002 to March 2013. Treatment failure was defined as receipt of a second antibiotic for UTI or entry into a hospital setting for UTI treatment.
The receipt of nitrofurantoin was associated with a higher likelihood of both negative outcomes when compared with ciprofloxacin and norfloxacin in both cohorts. Treatment with trimethoprim-sulfamethoxazole as opposed to nitrofurantoin was less likely to result in prescription of a second antibiotic among the cohort with relatively high filtration rates.
Despite these outcomes, nitrofurantoin was the most frequently-prescribed antibiotic among both cohorts, leading the researchers to suggest a revision in the treatment of UTIs.
“Our results are consistent with those of two other recent studies, which showed that the effectiveness of nitrofurantoin was unaffected by reduced estimated glomerular filtration rate in routine care,” the researchers wrote. “Given these findings, a review of multiple sources of information is needed to define optimal prescribing for urinary tract infection in general practice.”
Disclosures: Singh reports no relevant financial disclosures. Garg reports receiving an investigator-initiated grant from Astellas and Roche to support a Canadian Institutes of Health Research study in living kidney donors, and his institution has received unrestricted research funding from Pfizer.
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