Nitrofurantoin modified release versus trimetfaoprim or co-trimoxazole in the treatment of uncomplicated urinary tract infection in general practice

Abstract

A total of 538 patients from 45 different general practice centres across the UK was admitted to an open study and randomized to one of the following treatment groups: nitrofurantoin modified release (MR) 100 mg bd, trimethoprim 200 mg bd or co-trimoxazole 960 mg bd. Each patient received seven days of medication. Clinical cure, defined as relief from symptoms at visit 2, occurred in 87.2% of the patients treated with nitrofurantoin MR, 84.5% of the co-trimoxazole group and 86.5% of the trimethoprim group. The bacteriological cure rate for nitrofurantoin MR was comparable to co-trimoxazole at 82.3% and 83.2%, respectively, with trimethoprim the lowest at 76.8%. Whilst the cure rate for Escherichia coli infection was similar, 81.5% cured with nitrofurantoin MR, 82.5% with co-trimoxazole and 78.4% by trimethoprim, for non-E. coli pathogens nitrofurantoin MR was equivalent to co-trimoxazole with 86.7% cure but higher than trimethoprim at 72.0%. In-vitro sensitivity to all pathogens isolated at baseline was very high for nitrofurantoin at 96.1%, significantly higher than either co-trimoxazole or trimethoprim at 87.5% (P < 0.01). The test drugs were equally well tolerated with 28 patients (15.7%) reporting adverse events with nitrofurantoin MR, 28 (15.5%) with co-trimoxazole and 28 (15.6%) with trimethoprim. However, nitrofurantoin MR showed fewer patients with drug-related adverse events (5.6%) as judged by the investigator, compared to co-trimoxazole (8.8%) or trimethoprim (7.3%). (ABSTRACT TRUNCATED AT 250 WORDS)

Nitrofurantoin Compares Favorably to Recommended Agents as Empirical Treatment of Uncomplicated Urinary Tract Infections in a Decision and Cost Analysis

“…For simplicity, the Figure does not include the probability of vaginal yeast infection, which was calculated for each outcome on the basis of published probabilities. 7,[22][23][24][25] Other potential antibiotic effects or complications (eg, StevensJohnson syndrome) were considered rare and not included in our model, given that a previous investigation of uncomplicated UTIs found that expensive but uncommon events had almost no effect on overall treatment costs. 26 Finally, a model was constructed that compared all 3 treatments: nitrofurantoin, TMP-SMX, and fluoroquinolones.…”

“…Additionally, nitrofurantoin has retained a high prevalence of sensitivity to most uropathogens and has a favorable side-effect profile. 7 A recently published randomized trial demonstrated that nitrofurantoin for 5 days is as effective as TMP-SMX for 3 days in treating acute UTI in women. 8 Moreover, nitrofurantoin, like TMP-SMX, is less expensive than fluoroquinolones in many communities.…”

“…Probabilities for clinical events were obtained from published estimates, [3][4][5]7,8,[23][24][25]31,37,[40][41][42][43][44][45][46][47][48][49] with use of the mean value as the point estimate in the model (Table 2). These estimates were derived from previous models and the systematic review of the literature.…”

Treatment of acute uncomplicated cystitis - A clinical review

“…In 1967 a macrocrsitalline form with improved gastrointetinal tolerance became available [20,25,33]. Nowadays, there are two basic presentations of nitrofurantoin: the macrocrystalline form and a mixture of the microcrystalline and macrocrystalline forms (25 mg macrocristals plus 75 mg monohydrate form) [25,33], blended in a patented dual delivery system, which is known in USA as nitrofurantoin monohydrate/macrocristals [34]. For therapy of UTIs nitrofurantoin in the macrocrystalline formulation is given orally at 50 to 100 mg four times daily [20,25].…”

“…For therapy of UTIs nitrofurantoin in the macrocrystalline formulation is given orally at 50 to 100 mg four times daily [20,25]. The dose of the mixture of microcrystalline and macrocrystalline formulation is 100 mg twice a day [25,33,34]. This latter presentation is not commercialized in Spain.…”