Nitrofurantoin beats fosfomycin for uncomplicated UTI

MADRID – Five days of nitrofurantoin was significantly more effective than was a single large dose of fosfomycin in effecting both clinical and microbiological cure among women with uncomplicated lower urinary tract infections (UTIs), a randomized study has determined.

By 28 days, clinical resolution had occurred in 70% of those who took nitrofurantoin and 58% of those who took fosfomycin – a statistically significant 12% difference, Angela Huttner, MD, said at the European Society of Clinical Microbiology and Infectious Diseases annual congress.

But the benefit was even more pronounced in women whose infections were caused by Escherichia coli, with a 28% spread in clinical resolution, (78% vs. 50%) and a 14-point spread in microbiological cure (72% vs. 58%), said Dr. Huttner of Geneva University, Switzerland.

The results were simultaneously published online in JAMA (2018 Apr 22. doi: 10.1001/jama.2018.3627).

^{Michele G. Sullivan/MDedge News}

Dr. Angela Huttner

Despite its success, nitrofurantoin did not live up to its purported 96% UTI cure rate – an established number based on study data from the 1950s-1970s.

Such efficacy was probably a false finding, she said. Studies of that era were much less rigorous than they are today, Dr. Huttner pointed out. The primary endpoint in those studies was typically defined not as complete resolution of symptoms – as it was in her study – but as resolution or improvement.