Nitrofurantoin versus Trimethoprim Prophylaxis in Recurrent Urinary Tract Infection in Children

Abstract

ABSTRAm. Copenhagen study group of urinary tract infections in children (Departmentsmark.) Nitrofurantoin versus trimethoprim prophylaxis in recurrent urinary tract infection in children. A randomized, double-blind study. Acta Paediatr Scand 79: 1225,1990. The efficiency of nitrofurantoin and trimethoprim prophylaxis in preventing recurrent urinary tract infections (UTI) was compared by means of actuarial percentage recurrence-free c w e s in a randomized, double blind study in 130 children (126 girls, 4 boys) aged 1 to 14 years (mean 7.5). The children received the antibiotics for 6 months. Nitrofurantoin proved to be the most efficient prophylactic drug in patients with abnormal urography and/or reflux (n=60) as evaluated by actuarial percentage recurrence-free analysis (p= 0.0025). However, no differences was found in patients without urinary tract abnormalities. Nitrofurantoin prophylaxis altered neither the pattern of resistance nor the bacteriological constellation, while patients receiving trimethoprim prophylaxis had 76 % trimethoprim resistant bacteria during prophylaxis, compared with 8 % before (p< 0.0001) and 17 % after (p< 0.0001) prophylaxis. The percentage of recurrences due to E. coli (70430%) was unaffected by trimethoprim prophylaxis, but the proportion due to trimethoprim resistant E. coli was significantly higher during prophylaxis (65%) than before (6%, p<O.OOOl) and after ( l l % , p < 0.001). The percentage of Sfuphylococcus epidermidis UTI was significantly higher during trimethoprim prophylaxis (27 %) than before (2 %, p < 0.0003). Following prophylaxis there was no difference in the actuarial percentage recurrence-free curves of the two regimens. Side effects occurred more frequently in the nitrofurantoin group (37%) than in the trimethoprim group (21 %) (p=0.05). The majority of side effects in the nitrofurantoin group derived from gastrointestinal symptoms. In conclusion, nitrofurantoin is recommended as the first choice prophylactic treatment of children with recurrent UTI and urinary tract abnormalities.

Nitrofurantoin's efficacy and safety as prophylaxis for urinary tract infections: a systematic review of the literature and meta-analysis of controlled trials

“…In the Brendstrup trial comparing nitrofurantoin to trimethoprim prophylaxis in children over 6 months, six of the 67 (9%) children randomized to nitrofurantoin carried strains resistant to it at baseline; during prophylaxis, 4/60 (7%) had at least one resistant bacterium. In contrast, although five of the 63 (8%) patients receiving trimethoprim carried bacteria resistant to this drug at baseline, 28/60 (47%) harboured a trimethoprim-resistant bacterium by the study's end [16]. No other studies provided both baseline and follow-up microbiological data.…”

Preventing Urinary Tract Infections in Early Childhood

“…Five trials have compared one antibiotic with another [25][26][27][28][29], two of which compared cotrimoxazole with nitrofurantoin [26,29]. These two trials were small (N of 120 and 132) but both demonstrated statistically significant superiority of nitrofurantoin (risk ratios (RR) 0.57 (95 % CI 0.35-0.92) and 0.32 (95 % CI 0.19-0.56)).…”

“…These two trials were small (N of 120 and 132) but both demonstrated statistically significant superiority of nitrofurantoin (risk ratios (RR) 0.57 (95 % CI 0.35-0.92) and 0.32 (95 % CI 0.19-0.56)). However, one study [26] reported 30 % of patients withdrawing from the study due to side effects of nitrofurantoin suggesting the acceptability of this treatment may be poor.…”

Hot Topics in Infection and Immunity in Children III

“…The presence of E. coli resistant to trimethoprim has been demonstrated in up to 66% of children on antibiotic prophylaxis following breakthrough infection, suggesting that prophylaxis may play a role in inducing the emergence of antibiotic-resistant organisms (Braendstrup et al, 1990). Moreover, there is an 8-10% risk of adverse reactions with antimicrobial prophylaxis .…”