Nitrofurantoin in urinary infection

Uncomplicated urinary infections, once easy to deal with, have now become difficult to treat due to many pathogens developing antibiotic resistance, in particular towards trimethoprim-sulfamethoxazole (TMP-SMX) and quinolones in general. As a first-line treatment, physicians are now proposing the rediscovery of nitrofurantoin, an antibiotic which used a lot in the past. Investigators from the Mayo Clinic carried out a study to compare a group of antibiotics used as a first-line empirical treatment of uncomplicated cystitis, including parameters such as cost-minimization, the necessity of additional treatment, the onset of pyelitis, pyelonephritis and other complications such as candidal vaginitis. When comparing a 3-day TMP-SMX or fluoroquinone treatment with a 5-day nitrofurantoin treatment, the latter was more cost-effective than the others, since TMP-SMX resistance exceeded 17%, and fluoroquinolone resistance exceeded 12% (under these values, the 3-day treatment scored better). Data concerning the U.S. show that TMP-SMX resistance at this time is generally 15%, with some areas peaking at 40%; for quinolones, resistance levels reach 20% in certain areas.

  1. McKinnell JA et al. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clinic Proceedings 2011 Jun; 86:480
(Urologia)

Il nostro commento:

This is the second time nitrofurantoin is described as an effective drug in the treatment of uncomplicated urinary infections. An earlier study by the Infectious Diseases Society of America had already recommended its use, based not on cost but on eco-friendliness and effectiveness, as it showed a minimal percentage of resistance by enterobacteriaceae, possibly also due to a long permanence of the drug in the urinary environment. Nevertheless, the negative aspects in the use of this drug are serious: it is contraindicated with creatinine levels < 60 ml/min, it is dangerous in patients with G6PDH deficiency, and it may induce lung disease, although rarely.
Gennaio 2012
  • Audio veloce - File size: 2143 Kb Tempo 2,17 min.
  • Audio lento - File size: 2367 Kb Tempo 2,31 min.

Diet and physical activity in type 2 diabetes

Increased physical activity and dietary management is universally recommended in the initial [...]

Intensive treatment in preclinical diabetes

When diabetes mellitus is diagnosed in a patient showing no symptoms, what is the best therapeutic [...]

How to measure blood pressure

What measurements should be used in the monitoring of blood pressure? The ones performed by [...]

Ultimo mese