Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women

Singh, Namisha; Gandhi, Sumeet; McArthur, Eric; Moist, Louise; Jain, Arsh K.; Liu, Aiden R.; Sood, Manish M.; Garg, Amit X.

doi:10.1503/cmaj.150067

Cited by 42 publications

(24 citation statements)

References 25 publications

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“…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]. Particularly in older adults, for whom adverse event profile and collateral damage to the microbiome are important considerations, nitrofurantoin is a good choice for uncomplicated UTIs, including in men with preserved renal function.…”

Section: Treatment Of Utismentioning

confidence: 72%

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Cortés-Penfield

Trautner

Jump

2017

Infectious Disease Clinics of North America

159

105

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Synopsis Urinary tract infections (UTIs) are a significant cause of morbidity among older adults; however, antibiotic prescriptions for clinically suspected UTIs are often inappropriate. Healthcare providers frequently struggle to differentiate UTI from asymptomatic bacteriuria, particularly in patients presenting with nonspecific symptoms. Patients with baseline cognitive impairments that limit history-taking can be particularly challenging. Here, we review the epidemiology and pathogenesis of UTI in older adults. We also discuss an approach to the diagnosis and treatment of UTIs, focusing on recognizing patients who would likely benefit from antibiotic treatment and on identifying patients for whom empiric antibiotic therapy should not be given.

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Section: Treatment Of Utismentioning

confidence: 72%

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Cortés-Penfield

Trautner

Jump

2017

Infectious Disease Clinics of North America

159

105

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“…Although the prevalence of nitrofurantoin resistance was low in Rotterdam and at the national level, we found that resistance in the age group of ≥ 70 years was higher than in the group < 70 years (OR 4.11; 95% CI 1.50-14.41; p = 0.01). After correction for multiple testing, this association was not statistically significant, but an impaired kidney function, which often occurs in the elderly, can make nitrofurantoin less effective in this age group [26]. Therefore, caution is needed when prescribing nitrofurantoin to older patients.…”

Section: Discussionmentioning

confidence: 90%

Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

Honsbeek

Tjon-A-Tsien

Stobberingh

et al. 2020

Eur J Clin Microbiol Infect Dis

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Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum β-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%-5.0% for high resistance and between 1.2%-3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.

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“…5 Nitrofurantoin is beneficial for treating UTIs in older women with low glomerular filtration rates. 23 Since nitrofurantoin reaches therapeutically active concentrations only in lower urinary tract, hence it is neither recommended for upper UTI treatment nor for men with UTI and concomitant prostatitis. 24 Acute Uncomplicated UTI-Acute uncomplicated cystitis is one of the most common health problems in the society for which young women seek medical attention.…”

Section: Discussion Therapeutic Uses Of Nitrofurantoinmentioning

confidence: 99%

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

Alam¹,

Rana²,

Bhardwaj³

et al. 2019

jemds

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BACKGROUND Urinary tract infections are often caused by bacteria resistant to antibiotics which have evolved to be a major health issue in recent years. Often, urinary tract infections are very hard to treat and if not appropriately treated in time, may result in serious consequences, particularly, when it spreads to kidneys ultimately resulting in an increase in morbidity and mortality. Nitrofurantoin, a first line agent and has bactericidal action, frequently used to treat uncomplicated urinary tract infection. The literature was searched with published sources from Medline, PubMed and Embase search engines. Published articles were searched, of which 81 articles were eligible to be included for this systematic review. Nitrofurantoin is reduced by the action of bacterial flavoproteins to reactive intermediate compounds that non-specifically inactivate ribosomal proteins resulting in inhibition of protein synthesis. Various mechanisms seem to be responsible for the reduced capability of microorganism to acquire resistance in a faster manner. Nitrofurantoin exhibits high quality success against most bacteria anticipated in urinary tract infection. Nitrofurantoin has been recommended for prophylaxis in the treatment of reinfection in case of recurrent uncomplicated urinary tract infections in many western countries. Nitrofurantoin is one of the treatment options for urinary tract infection due to extended spectrum beta lactamase producing Escherichia coli. In pregnant women with urinary tract infection, nitrofurantoin can be appropriate treatment. Also, nitrofurantoin associated reactions have been reported in many studies. This review updates the clinical use of nitrofurantoin, including new facts about the role of nitrofurantoin in the therapy of community acquired urinary tract infection, adverse outcomes, complications, interactions and antibiotic resistance mechanism against different uropathogens.

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Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women

Cited by 42 publications

References 25 publications

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands

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

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