Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study
Abstract
OBJECTIVES
Guidelines do not distinguish between 50 mg or 100 mg nitrofurantoin as daily prophylaxis for recurrent urinary tract infection (UTI), although 50 mg might have a better safety profile. Our objective was to compare the effectiveness and safety of both regimens.
METHODS
Data were retrospectively collected from 84 Dutch GP practices between 2013 and 2020. Nitrofurantoin prescriptions of 100 mg and 50 mg every 24 hours in women were included. Cox-proportional-hazard regression analysis was used to calculate hazard ratios (HRs) on first episode of UTI, pyelonephritis and (adverse) events. Patients were followed for the duration of consecutive repeated prescriptions, assuming non-informative right censoring, up to one year.
RESULTS
Nitrofurantoin prophylaxis was prescribed in 1,893 patients. Median lengths of follow-up were 90 days (IQR 37-179) for 100 mg (n=551) and 90 days (IQR 30-146) for 50 mg (n=1,342) with few differences in baseline characteristics between populations. Under 100 mg and 50 mg, 82/551 (14.9%) and 199/1,342 (14.8%) developed UTI and 46/551 (8.3%) and 81/1,342 (6.0%) developed pyelonephritis, respectively. Adjusted HRs of 100 mg versus 50 mg were 1.01 (95%CI: 0.78-1.30) on first UTI, 1.37 (95%CI: 0.95-1.98) on first pyelonephritis episode, 1.82 (95%CI: 1.20-2.74) on first consultation for cough, 2.68 for dyspnea (95%CI: 1.11-6.45) and 2.43 for nausea (95%CI: 1.03-5.74).
CONCLUSION
Daily prophylaxis for recurrent UTI with 100 mg instead of 50 mg…
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. Reported size: 1,893 participants or records.
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