An Update on the Role of Nitrofurans in the Management of Urinary Tract Infections

Abstract

There have been few recent reviews of the nitrofurans in the literature, and none include recently available data on the use of nitrofurazone (nitrofural) in the prevention of catheter-associated urinary tract infection (CAUTI). Nitrofurazone and nitrofurantoin are the only nitrofurans that have become established in clinical use in the 20th century. These 2 nitrofurans have remained clinically useful against a wide spectrum of gram-positive and gram-negative bacteria, including many strains of common urinary tract pathogens. Today, the primary use of nitrofurantoin is as an oral antibacterial treatment for genitourinary infections. Nitrofurazone is primarily used as a topical antibacterial agent in burns and skin grafts and recently was approved for the prophylaxis of CAUTI. The recent development of a nitrofurazone-impregnated catheter as a novel modality in the prevention of CAUTI reflects a renewed interest in the effectiveness of nitrofurans. In an era when concern about bacterial resistance to many anti-infective agents is growing, the nitrofurans have continued to be active against organisms that have developed resistance to antibacterials. The presence of multiple mechanisms of action for the nitrofurans might be expected to reduce the ability of bacteria to develop resistance. Considering that an emergence of resistance to the nitrofurans has not appreciably occurred after several decades of clinical use, the nitrofurans may be unique among common antibacterial agents in this regard.

Combinatorial discovery of polymers resistant to bacterial attachment

“…Biofilms present on the surface of medical devices provide the bacterial inocula for disease and can also serve as reservoirs of plasmids carrying antibioticresistance genes 4,5 . Most strategies for reducing biofilm-associated infections focus on the modification of existing materials that are used to manufacture in-dwelling medical devices by the incorporation of antibiotics 6,7 or other antimicrobials, such as silver salts, nitrofurazone, chlorhexidine, polymerized quaternary ammonium surfactants, antibacterial peptides and anionic nanoporous hydrogels [8][9][10][11][12][13][14][15] . These approaches aim to kill bacterial cells that attach to a material, but we believe that greater efficacy in preventing biofilm formation might be achieved by the development of new materials that are inherently resistant to biofilm formation 16 .…”

Antibiotic Resistance in Uropathogenic E. Coli Strains Isolated from Non-Hospitalized Patients in Pakistan

“…The percentages of resistances for both drugs appeared to be above the threshold level [10]. As an alternative choice, nitrofurantoin could be considered as a drug of choice, given the low level of resistance found against this antibiotic [17]. However, there is no data on the effectiveness of this drug in the treatment of male patients and pharmacokinetic properties of this antibiotic are not better than those of fluoroquinolones [16].…”

Types of urethral catheter for reducing symptomatic urinary tract infections in hospitalised adults requiring short-term catheterisation: multicentre randomised controlled trial and economic evaluation of antimicrobial- and antiseptic-impregnated urethral catheters (the CATHETER trial)

“…The drug then elutes over time into the external surfaceurethral mucosa and internal lumen-urinary boundaries. 55 …”