Nitrofurantoin for urinary tract infections in men: it is possible
Abstract
Most uropathogens are sensitive to nitrofurantoin. Urinary tract infections with systemic symptoms cannot be treated with nitrofurantoin. Unfortunately, the frequency of prostate involvement in (suspected) cystitis without anamnestic and physical features of tissue invasion is unknown. Clinical studies are limited to retrospective observational studies in which approximately one third of men received a second course of antibiotics within 60-90 days. Exact interpretation of the retreatment is difficult, but it is certainly not only explained by a failure of nitrofurantoin. In addition, the number of men who come to the emergency room with urosepsis during treatment with nitrofurantoin is probably outweighed by the large number of nitrofurantoin prescriptions. The oral alternative to nitrofurantoin is ciprofloxacin. However, this is undesirable because of side effects, more microbiome disturbance and resistance development. Therefore, nitrofurantoin is a valuable treatment option for a urinary tract infection in men, provided that systemic symptoms are absent.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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