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

Abstract

Objective: To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI). Patients and MethOds:We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs.Results: Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics.

Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial

“…11,12 Therefore, nitrofurantoin may be less harmful than and much preferred over other antimicrobials. 13,14 Also, the lower number of repeat consultations among patients for whom nitrofurantoin was prescribed may support the finding that nitrofurantoin does not predispose patients to resistance.…”

Nitrofurantoin in the treatment of extended-spectrum β-lactamase-producing Escherichia coli-related lower urinary tract infection

“…NFT has been used for a very long time for the treatment of UTIs, however the introduction of CIP to the market has limited its consumption. The fact that NFT is effective both in vitro and in clinical studies against ESBL-producing E. coli suggests that it may be an important and economical treatment option in the near future [13].…”

Membrane-Active Hydantoin Derivatives as Antibiotic Agents

“…To date, one hydantoin derivative, nitrofurantoin, has been approved to treat urinary tract infections. 10–16 As an old antibiotic, it has recently attracted considerable interest due to its low probability of bacterial resistance compared to that of other conventional antibiotics such as fluoroquinolones, 17,18 possibly owing to the mixed mechanisms of action of hydantoins. However, hydantoin derivatives including nitrofurantoin generally exhibit only moderate antibacterial activity, which may limit their further application in combating emergent antibiotic resistance.…”