This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (8)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Women's Health  • Women's Health, Other  • Prognosis/ Outcomes  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Kalpana Gupta, MD, MPH; Thomas M. Hooton, MD; Pacita L. Roberts, MS; Walter E. Stamm, MD

Arch Intern Med. 2007;167(20):2207-2212.

Background  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.

Trial Registration  clinicaltrials.gov Identifier: NCT00391651

Author Affiliations: Departments of Medicine and Schools of Medicine, Yale University, New Haven, Connecticut (Dr Gupta); University of Miami, Miami, Florida (Dr Hooton); and University of Washington, Seattle (Ms Roberts and Dr Stamm).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Validation of a Decision Aid to Assist Physicians in Reducing Unnecessary Antibiotic Drug Use for Acute Cystitis
Warren J. McIsaac, Rahim Moineddin, and Sue Ross
Arch Intern Med. 2007;167(20):2201-2206.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Risk Factors for Trimethoprim-Sulfamethoxazole Resistance in Patients with Acute Uncomplicated Cystitis
Colgan et al.
Antimicrob. Agents Chemother. 2008;52:846-851.
ABSTRACT | FULL TEXT  

Keeping Urinary Tract Infection Simple
JWatch Emergency Med. 2008;2008:2-2.
FULL TEXT  

Short-Course Nitrofurantoin for Uncomplicated Cystitis in Women
JWatch Infect. Diseases 2007;2007:3-3.
FULL TEXT