Nitrofurantoin Beats Fosfomycin for UTI in Women

Written by Clay Smith

Spoon Feed
Nitrofurantoin was clearly superior to fosfomycin for uncomplicated UTI in adult women.

Why does this matter?
Resistance to common antibiotics for UTI is increasing.  Both nitrofurantoin and fosfomycin have historically been effective against common UTI pathogens.  Fosfomycin is an attractive option due to one-time oral dosing, but does it still work?

We have a winner
This was a multi-center RCT of adult women with uncomplicated lower UTI comparing 255 women on nitrofurantoin 100mg po tid x 5 days vs 258 women on fosfomycin 3g po x 1.  At 28 days, the nitrofurantoin group had improved clinical (70% vs 58%) and microbiologic (74% vs 63%) cure compared to fosfomycin.  Both had rare, mild GI side effects.  Nitrofurantoin is the clear winner for uncomplicated UTI in women.

Source
Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial.  JAMA. 2018 May 1;319(17):1781-1789. doi: 10.1001/jama.2018.3627.

Another Spoonful
PharmERToxGuy - Bryan Hayes did an outstanding synopsis of this article.

Reviewed by Thomas Davis

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