#Nitrofurantoin mono update#

An earlier review concluded that nitrofurantoin has an overall equivalence to trimethoprim/sulfamethoxazole, ciprofloxacin, and amoxicillin for the treatment of uUTI, but an update on the literature is needed. Nitrofurantoin has also shown to be effective in the prevention of UTIs. In a large study in Canada and European countries resistance to nitrofurantoin was low in Escherichia coli (E Coli), <3%, while rates were higher with ampicillin (30%), sulphonamides (29%), trimethoprim (15%), and trimethoprim/sulfamethoxazole (14%). ДЄ systematic review in 2015 concluded that nitrofurantoin toxicity is mild and predominantly gastrointestinal with low resistance rates. At a concentration >100 Ојg/mL, nitrofurantoin is a bactericide while it is bacteriostatic against organisms at concentrations <32 Ојg/mL. The drug is excreted in the urine achieving levels of 200 Ојg/mL or more. Nitrofurantoin bioavailability is about 90% with 40% of urinary excretion. Susceptibility to nitrofurantoin is reached if organismsвЂ™ minimum inhibitory concentration is 32 Ојg/mL or less. However, the recommended regimen is 7 days, which has hampered its popularity in comparison to shorter or single-dose regimens, and there has been concern about resistance, but if given for only 3 days, nitrofurantoinвЂ™s clinical efficacy diminishes. Nitrofurantoin has been used as a treatment for uUTI since the 1950s. According to the updated guidelines by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases, the first-line agents recommended for treating uUTI are nitrofurantoin monohydrate/macrocrystals and triВmethoprim-sulfamethoxazole, although the latter was noted to have inferior efficacy compared with standard short-course regimens. Treatment options for UTI are becoming more limited due to increasing resistance to UTI antibiotics. Most UTIs are defined as uncomplicated (uUTI), defined as UTI in a person who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. Urinary tract infection (UTI) is a common disorder by the age of 32 years, half of all women report having at least 1 previous UTI. More robust research with well-designed double-blinded RCTs is needed. Although no firm conclusions can be made on the current base of evidence, the studies generally suggest that nitrofurantoin is at least comparable to other common uUTI treatments in terms of clinical and bacteriological cure. Key Messages: Evidence on the clinical and bacteriological efficacy of nitrofurantoin is sparse, with a lack of new data, and hampered by high risk of bias. Patients taking nitrofurantoin reported fewer side effects than other drugs and the most commonly reported were gastrointestinal and central nervous system symptoms. Overall the evidence suggests that nitrofurantoin is at least comparable with other uUTI treatments in terms of efficacy.

The clinical cure rates in nitrofurantoin ranged from 51 to 94% depending on the length of follow-up, and bacteriological cure rates ranged from 61 to 92%. Overall study quality was poor with a high risk of bias. The most common comparators were trimethoprim-sulfamethoxazole and fosfomycin tromethamine. RCTs were a mixture of double-blind, single-blind, and open-label trials. We searched 4 databases for articles published from database inception to May 6, 2020: (1) PubMed electronic database of the National Library of Medicine, (2) Web of Science, (3) Embase, and (4) Cochrane Library. Summary: The review was performed according to PRISMA guidelines. A secondary aim is to assess whether nitrofurantoin use is associated with increased side effects compared to other treatment regimens. Objective: To provide an updated systematic review of randomized control trials (RCTs) to investigate the clinical and microbiological efficacy of nitrofurantoin compared to other antibiotics or placebo for treatment of uncomplicated urinary tract infections (uUTI).

Nitrofurantoin mono