Relooking at Nitrofurantoin as drug of choice for empiric treatment of community acquired uncomplicated urinary tract infections: An effective and economic treatment option

Abstract

Introduction: Urinary tract infections (UTI) caused by multidrug resistant bacteria necessitate the use of broad spectrum expensive antibiotics, which enhance antibiotic pressure. It would be ideal to look at older less commonly prescribed antibiotics like nitrofuratoin and assess its sensitivity for treatment of community acquired UTIs. Nitrofurantoin has been used successfully for prophylaxis and treatment of acute lower UTIs in adults, children and pregnant women. Aim and objectives: This study aims to assess the in-vitro sensitivity of common uropathogens to nitrofurantoin including ESBL producers. Materials and methods : Urine culture and bacterial identification was by standard tests and antibiotic sensitivity was assessed by Kirby Bauer disc diffusion method. ESBL producers were identified by CLSI recommended double disk synergy test. Results: 226 (29.89) % of 756 urine samples showed significant bacteruria, of which 122 (53.98%) were E.coli , 32 (14.15%) K.pneumoniae , 23 (10.17%) P.aeruginosa , 14 (6.19%) Enterococcus spp., 12 (5.30%) Acinetobacter spp, 10 (4.42%) S.saprophyticus and 5 (2.3%) were Candida species. 111/122 (90.98%) of E.coli were sensitive to nitrofurantoin, of which 40 were ESBL producers. 37/40 (92.5%) ESBL producing E.coli and all isolates of S.saprophyticus and Enterococcus spp. were sensitive to nitrofurantoin. Conclusions: Nitrofurantoin is an oral antibiotic with minimal adverse effects, having high in-vitro sensitivity against common community acquired uro-pathogens and is reasonably priced. Hence there is a need to reconsider nitrofurantoin as drug of choice for treatment of community acquired uncomplicated lower UTIs. This could ease the antibiotic pressure, off oral cephalosporins and fluoroquinolones which are currently overused in the community