Journal of Antimicrobial Chemotherapy, Vol 42, 363-371, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
W Brumfitt and JM Hamilton-Miller
Case records from 219 female patients between 1975 and 1992 who were given
long-term prophylaxis (1 year) with nitrofurantoin for the prevention of
recurrent urinary infections have been reviewed. Patients' age ranged from
9 to 89 years (median 31-35 years, mode 26-30 years); most (61%) were <
40 years old. The median number of symptomatic episodes in the 12 months
immediately before prophylaxis was six (mode 4, mean 6.9). 14.4% of the
patients were allergic to an antibiotic, and 23.6% had an imaging
abnormality. Three regimens were used: group A (43 patients), 50 mg
microcrystalline nitrofurantoin, bd; group B (110 patients), 100 mg
macrocrystalline nitrofurantoin (Macrodantin), od; group C (66 patients),
50 mg Macrodantin, od. There were no obvious differences in efficacy
between the patient groups (173 assessable patients). The mean incidence of
symptomatic episodes decreased 5.4-fold during prophylaxis. Four-fifths of
the 43 breakthrough infections (mostly due to Escherichia coli), were
caused by nitrofurantoin-sensitive strains. An important finding was that
patients with an imaging abnormality responded as well as those with no
such abnormalities. In 16% of patients, prophylaxis was not helpful,
objectively or subjectively, for no obvious reasons. In most patients where
prophylaxis was successful, clinical improvement was maintained for at
least 6 months after the end of prophylaxis. Nausea was more common in
group A (P < 0.001), as were 'all adverse events'. Of those in group A
25.6% stopped prematurely as a result of an adverse event of any type,
compared with 13% of those taking Macrodantin (P < 0.01). Older patients
(> 65 years) did not report more adverse events than younger patients.
No adverse event was life-threatening. Faecal flora analysis showed neither
overgrowth by nitrofurantoin-resistant bacteria nor elimination of
sensitive coliforms. Thus, macrocrystalline nitrofurantoin 50 mg at bedtime
is appropriate for use in the long-term (12 months) prophylaxis of
recurrent urinary infections, in view of its efficacy and favourable safety
and tolerability profile. Patients can be managed by their family doctor.
REVIEWS
Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years' experience
Urinary Infection Clinic, Royal Free Hampstead NHS Trust, and Department of Medical Microbiology, Royal Free Hospital School of Medicine, London, UK.
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