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Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women.

AbstractBACKGROUND:
There is a paucity of data on the efficacy of nitrofurantoin for the treatment of acute uncomplicated cystitis in regimens shorter than 7 days. Evidence-based use of this drug is increasingly important as trimethoprim-sulfamethoxazole resistance among uropathogens increases.
METHODS:
To assess the efficacy of nitrofurantoin vs trimethoprim-sulfamethoxazole, 338 women aged 18 to 45 years with acute uncomplicated cystitis were randomized to open-label treatment with either trimethoprim-sulfamethoxazole, 1 double-strength tablet twice daily for 3 days, or nitrofurantoin, 100 mg twice daily for 5 days. Clinical cure 30 days after therapy was the main outcome measure. Secondary outcomes included clinical and microbiological cure rates 5 to 9 days after therapy and, for trimethoprim-sulfamethoxazole-treated women, clinical cure stratified by the trimethoprim-sulfamethoxazole susceptibility of the uropathogen.
RESULTS:
Clinical cure was achieved in 79% of the trimethoprim-sulfamethoxazole group and in 84% of the nitrofurantoin group, for a difference of -5% (95% confidence interval, -13% to 4%). Clinical and microbiological cure rates at the first follow-up visit were also equivalent between the 2 groups. In the trimethoprim-sulfamethoxazole arm, 7 of 17 women (41%) with a trimethoprim-sulfamethoxazole-nonsusceptible isolate had a clinical cure compared with 84% of women with a trimethoprim-sulfamethoxazole-susceptible isolate (P < .001).
CONCLUSION:
A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women.
AuthorsKalpana Gupta, Thomas M Hooton, Pacita L Roberts, Walter E Stamm
JournalArchives of internal medicine (Arch Intern Med) Vol. 167 Issue 20 Pg. 2207-12 (Nov 12 2007) ISSN: 0003-9926 [Print] United States
PMID17998493 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Infective Agents, Urinary
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Nitrofurantoin
Topics
  • Acute Disease
  • Adolescent
  • Adult
  • Anti-Infective Agents, Urinary (administration & dosage)
  • Cystitis (drug therapy, microbiology, urine)
  • Drug Administration Schedule
  • Drug Resistance, Microbial
  • Female
  • Humans
  • Microbial Sensitivity Tests
  • Middle Aged
  • Nitrofurantoin (administration & dosage)
  • Time Factors
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination (administration & dosage)

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