Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency

Abstract

Background The emergence of antimicrobial resistance in uropathogens has generated interest in the use of nitrofurantoin in controversial populations, such as in males and in those with renal dysfunction. The purpose of this study is to compare the efficacy and safety of nitrofurantoin for the treatment of cystitis in males and females with variable degrees of renal dysfunction. Methods A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting. The primary outcome was clinical cure compared between males and females and across various renal function groups (CrCl > 60 mL/min, 30-60 mL/min, and < 30 mL/min) following nitrofurantoin treatment. The secondary outcome was adverse events. Results A total of 446 patients were included with 278 females and 168 males. Overall clinical cure rate was 86.5% [95% CI 83.0, 89.4%] (n=386). Clinical cure rate did not vary between genders (OR 0.6 [95% CI 0.35, 1.04], p=0.085) or between patients who have a CrCl > 60 mL/min compared to those with CrCl 30-60 mL/min (OR 1.01 [95% CI 0.40, 2.44], p=1). The one patient with a CrCl < 30 mL/min was not included in the analysis. A history of benign prostatic hyperplasia (BPH) (OR 0.5 [95% CI 0.26, 0.99], p=0.045) or cirrhosis (OR 0.21 [95% CI 0.06, 0.82], p=0.025) was associated with decreased odds of clinical cure. Adverse events occurred in 2% (n=9) of patients. Conclusions There was no statistically significant difference in clinical cure with nitrofurantoin between genders and various renal functions.