Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications

Cunha, Burke A.; Cunha, Cheston B.; Lam, B; Giuga, J.; Chin, Jamie; Zafonte, Veronica B; Gerson, Steve

doi:10.1007/s10096-017-2911-1

Cited by 20 publications

(12 citation statements)

References 28 publications

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“…7 Relativamente à nitrofurantoína, o seu uso é por vezes visto com alguma apreensão na prática clínica, devido à necessidade de um tratamento prolongado, com várias administrações diárias, e ao receio de possível toxicidade e menor eficácia perante diminuição da função renal. 18,22 O facto de não ser muito utilizada poderá justificar a manutenção de um elevado perfil de sensibilidade por parte da E. coli. 18 Há que realçar que estes antibióticos não apresentam uma boa penetração parenquimatosa, pelo que não são adequados para o tratamento de pielonefrites ou de infeções urinárias com envolvimento prostático.…”

Section: Discussionunclassified

Perfil de Sensibilidade aos Antibióticos na Infeção Urinária em Ambulatório no Distrito de Coimbra: Um Estudo Transversal

C¹,

Rosendo²,

Santiago³

2019

Acta Med Port

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Introduction: Urinary tract infections in the community setting are quite common. It is necessary to be aware of antibiotic susceptibility patterns in order to provide rational empirical therapy. The aim of this study is to determine the frequency and antimicrobial susceptibility of the strains responsible for urinary tract infections in primary health care, in the district of Coimbra, Portugal.Material and Methods: In this observational and cross-sectional study, we analyzed 7134 positive urine cultures of outpatient laboratories in the district of Coimbra, over one year. In most cases, a positive culture was defined by a threshold of 105 colony-forming units per milliliter and was conducted by the automated system VITEK® 2, by bioMérieux. We used descriptive and inferential statistics to determine the prevalence and antimicrobial susceptibility of bacteria and to ascertain whether there were differences associated with sex and age.Results: From the total of positive cultures, 83.4% pertained to females and 41.0% to individuals over 75 years old. Escherichia coli was the most frequent strain (63.9%), although its prevalence was lower (p < 0.001) in males and individuals over 75 years old. Its susceptibility to fosfomycin and nitrofurantoin was higher than 95% and with ciprofloxacin and trimethoprim/sulfamethoxazole it was lower than 80%. Resistances were more frequent (p < 0.001) in males and in the elderly.Discussion: Escherichia coli was the most frequent strain, revealing less resistance to fosfomycin and nitrofurantoin. Antimicrobial susceptibility was lower in the elderly and in males, populations in whom empirical therapy may be less successful.Conclusion: In order to improve clinical results, we recommend periodic surveillance of antimicrobial susceptibility, which could enable the provision of efficient information to clinicians, namely those who prescribe empirically for such infections, as well as standardization of identification methods of bacterial strains diagnosis and of the antibiotic kits to be tested.

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Section: Discussionunclassified

Perfil de Sensibilidade aos Antibióticos na Infeção Urinária em Ambulatório no Distrito de Coimbra: Um Estudo Transversal

C¹,

Rosendo²,

Santiago³

2019

Acta Med Port

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“…Based on these findings, we suggest that nitrofurantoin may be another alternative option for treating uncomplicated UTI caused by ESBL-EC infection. [ 16 ] Cotrimoxazole and quinolones are one of few oral therapeutic options for ESBL-producing isolates. However, in this study, it was the least active antimicrobial agent against ESBL-EC and ESBL-KP isolates [ Table 1 ].…”

Section: Discussionmentioning

confidence: 99%

Nitrofurantoin and Fosfomycin for Extended Spectrum Beta-lactamases Producing Escherichia coli and Klebsiella pneumoniae

Tulara¹

2018

J Global Infect Dis

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Urinary tract infection (UTI) is a common and painful human illness that, unfortunately not responsive to commonly used antibiotics in current practice. The role of fosfomycin and nitrofurantoin in the era of growing bacteria resistance has been widely discussed. In this study, we aimed to know the local antimicrobial susceptibilities, fosfomycin and nitrofurantoin susceptibility in particular, for urinary extended-spectrum-beta-lactamase-producing Escherichia coli and Escherichia pneumoniae (ESBL-EC and ESBL-KP) isolates in our hospital. We collected 464 urine isolates, including 384 ESBL-EC and 80 ESBL-KP isolates. Of 464 urine isolates culture positive ESBL-UTIs, EC caused 384 (82.75%), followed by Klebsiella in 80 (17.24%). Carbapenems and Colistin seems to remain as the first line therapy for the majority of ESBL-UTIs in the local setting. Colistin and fosfomycin remains the most sensitive antibiotic while nitrofurantoin still preserves the good sensitivity against ESBL and found to be an only oral sensitive antibiotic.

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“…The extended-release formulation consists of 25 mg of nitrofurantoin in the form of macrocrystals and 80.7 mg in the form of monohydrate, corresponding to 75 mg of anhydrous nitrofurantoin. The NF50 formulation has been available since 1969 and needs to be taken every 6 h, while the NF100 formulation was registered in 1994 and can be taken every 12 h 6 . Pharmacokinetic studies suggest that the NF100 extended-release formulation could be superior to NF50 3 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of extended- versus normal-release nitrofurantoin for cystitis: an instrumental variable analysis

Doesschate

Bonten

Werkhoven

2019

Journal of Antimicrobial Chemotherapy

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BackgroundIt is unknown whether nitrofurantoin 50 mg normal-release every 6 h (NF50) and nitrofurantoin 100 mg extended-release every 12 h (NF100) are equally effective for treating cystitis in primary care. In the Netherlands, GP prescription of either option largely depends on pharmacy procurement, rather than on patient-related factors.MethodsGP data between January 2013 and July 2018 were retrospectively collected. Inclusion criteria were the use of nitrofurantoin for uncomplicated cystitis, complicated cystitis or cystitis in pregnancy. Criteria for early and late failure were a second antibiotic prescription for cystitis or pyelonephritis within 14 and 28 days post-prescription, respectively. Crude and confounder-adjusted (CA) risk differences (RDs) were estimated using linear regression. Instrumental variable analysis and CA instrumental variable analysis used GP practice proportion of NF50 versus NF100 use as the instrumental variable.ResultsFor uncomplicated cystitis (n=46855), treatment with NF50 and NF100 resulted in late failure in 9.7% and 9.6%, respectively. The CA RD, instrumental variable RD and CA instrumental variable RD were 0.2% (95% CI=−0.5 to 0.8), −0.7% (95% CI=−1.7 to 0.3) and 0.0% (95% CI=−0.9 to 1.0), respectively. In complicated cystitis (n=10767), late failure occurred in 10.9% and 11.1% after using NF50 and NF100, respectively [CA RD=0.5% (95% CI=−1.2 to 1.8), instrumental variable RD=−0.8% (95% CI=−3.4 to 1.8) and CA instrumental variable RD=−0.3% (95% CI=−3.0 to 2.4)]. For cystitis in pregnancy (n=1087), NF50 and NF100 resulted in late failure in 13.4% and 7.8%, respectively [CA RD=−5.4% (95% CI=−10.0 to −1.4), instrumental variable RD=−8.9% (95% CI=−16.0 to −1.8) and CA instrumental variable RD=−8.9% (95% CI=−16.0 to −1.7)]. No differences were observed in early failure.ConclusionsIn patients with cystitis in pregnancy, NF100 was associated with a lower incidence of late clinical failure compared with NF50. We found no differences in clinical failure between NF50 and NF100 for uncomplicated and complicated cystitis.

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Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications

Cited by 20 publications

References 28 publications

Perfil de Sensibilidade aos Antibióticos na Infeção Urinária em Ambulatório no Distrito de Coimbra: Um Estudo Transversal

Perfil de Sensibilidade aos Antibióticos na Infeção Urinária em Ambulatório no Distrito de Coimbra: Um Estudo Transversal

Nitrofurantoin and Fosfomycin for Extended Spectrum Beta-lactamases Producing Escherichia coli and Klebsiella pneumoniae

Effectiveness of extended- versus normal-release nitrofurantoin for cystitis: an instrumental variable analysis

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