TY - JOUR
T1 - Nitrofurantoin failure in males with an uncomplicated urinary tract infection
T2 - a primary care observational cohort study
AU - Platteel, Tamara N.
AU - Beets, Marijn T.
AU - Teeuwissen, Hendrik A.
AU - Doesschate, Thijs Ten
AU - van de Wijgert, Janneke Hhm
AU - Venekamp, Roderick P.
AU - van de Pol, Alma C.
N1 - Funding Information:
The authors would like to thank the GPs for sharing their anonymous patient care data with the Julius General Practitioners’ Network.
Publisher Copyright:
©The Authors.
PY - 2023/3/1
Y1 - 2023/3/1
N2 - BACKGROUND: Nitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable. AIM: To compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline. DESIGN AND SETTING: Retrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020. METHOD: Medical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression. RESULTS: Most UTI episodes in males were uncomplicated (n = 6805/10 055 episodes, 68%). Nitrofurantoin was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin (n = 1887, 28%), amoxicillin/clavulanic acid (n = 470, 7%), and trimethoprim/sulfamethoxazole (n = 285, 4%). Antibiotic failure occurred in 25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure. CONCLUSION: Nitrofurantoin failure was common in males with uncomplicated UTI and increased with age.
AB - BACKGROUND: Nitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable. AIM: To compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline. DESIGN AND SETTING: Retrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020. METHOD: Medical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression. RESULTS: Most UTI episodes in males were uncomplicated (n = 6805/10 055 episodes, 68%). Nitrofurantoin was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin (n = 1887, 28%), amoxicillin/clavulanic acid (n = 470, 7%), and trimethoprim/sulfamethoxazole (n = 285, 4%). Antibiotic failure occurred in 25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure. CONCLUSION: Nitrofurantoin failure was common in males with uncomplicated UTI and increased with age.
KW - Adult
KW - Anti-Bacterial Agents/therapeutic use
KW - Cohort Studies
KW - Humans
KW - Male
KW - Nitrofurantoin
KW - Primary Health Care
KW - Retrospective Studies
KW - Urinary Tract Infections/drug therapy
KW - nitrofurantoin
KW - treatment failure
KW - general practice
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85148819185&partnerID=8YFLogxK
U2 - 10.3399/BJGP.2022.0354
DO - 10.3399/BJGP.2022.0354
M3 - Article
C2 - 36823068
SN - 0960-1643
VL - 73
SP - e204-e210
JO - The British journal of general practice : the journal of the Royal College of General Practitioners
JF - The British journal of general practice : the journal of the Royal College of General Practitioners
IS - 728
ER -