Effectiveness and safety of nitrofurantoin in outpatient male veterans

Abstract

Objectives: The aim of the study was to assess both the safety and the effectiveness of nitrofurantoin in male veterans treated for urinary tract infections (UTIs) with varying degrees of renal impairment in the outpatient setting. Nitrofurantoin is an important oral option for treating UTIs given increasing resistance to commonly used agents. Nitrofurantoin is currently contraindicated in patients with a creatinine clearance (CrCl) of < 60 ml/min, but the reason for this threshold has not been well documented. Methods: Data were collected through a retrospective chart review from January 2004 to July 2013 of men who had received nitrofurantoin. Bivariate analyses followed by multivariate analyses were performed between patients experiencing clinical cure and those who did not, to determine factors significantly impacting effectiveness. Results: The Gram stain of the organism causing the UTI and CrCl were significant factors impacting effectiveness. For every 1 ml/min increase in CrCl, the odds of clinical cure increased by 1.3%. Patients with Gram-negative UTIs predictably had 80% cure rates with CrCl around 60 ml/min. Patients with Gram-positive UTIs required higher CrCl, nearing 100 ml/min, to establish an 80% cure rate. Adverse effects did not vary with CrCl. Conclusions: The odds of clinical cure varied with CrCl and with the type of organism causing the UTI, while adverse events did not differ based on renal function. A minimum CrCl of 60 ml/min is suggested for men to achieve an 80% cure rate for UTIs with the most common urinary pathogens.

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

“…However, nitrofurantoin achieves poor levels in tissue and serum and thus is only appropriate in patients who have cystitis without suspicion for upper tract disease. A retrospective study of male veterans with UTI treated with nitrofurantoin showed a clinical cure rate of 77% rate, which is comparable to other agents [71]. Decreased creatinine clearance predicted clinical failure in this study; however, two additional studies in older adults, one limited to women, refuted the concern that nitrofurantoin is less effective in treating UTI in patients with reduced creatinine clearance [72–73].…”

Role of Nitrofurantoin in the Management of Urinary Tract Infection - A Systematic Review

“…Nitrofurantoin is especially used to treat UTIs caused by Gram-negative bacteria, particularly Escherichia coli. 22 Nitrofurantoin is being advised for adults and children in the therapy of acute symptomatic UTIs. Also, prescribed for the treatment of recurrent UTIs and for the prophylaxis of recurrent UTIs.…”

“…Nitrofurantoin is bactericidal in nature, nonspecific molecular target, and limited exposure beyond urinary tract may have the advantage with low resistance rate seen with this antibiotic. 22 Nitrofurantoin has remained successful after many decades of extensive use worldwide with very low resistance rate. 76 Nitrofurantoin ESBL production (24%)…”

Antibiotic switch after treatment with UTI antibiotics in male patients

“…However, there are ongoing discussions regarding the safety and efficacy of treating acute cystitis in male patients as uncomplicated UTIs [13]. Some newer studies suggest that men with acute cystitis do not need treatment for more than 5-7 days [14][15][16], and others argue that nitrofurantoin or pivmecillinam are appropriate as empirical treatment options [17,18].…”