Effectiveness and safety of nitrofurantoin in outpatient male veterans

Area of Science:

• Pharmacology
• Nephrology
• Infectious Diseases

Background:

• Nitrofurantoin is a key oral antibiotic for urinary tract infections (UTIs).
• Current guidelines contraindicate nitrofurantoin for patients with creatinine clearance (CrCl) below 60 ml/min.
• The rationale for this contraindication is not well-established.

Purpose of the Study:

• To evaluate the safety and effectiveness of nitrofurantoin in male veterans with UTIs and varying renal function.
• To investigate factors influencing nitrofurantoin's efficacy in an outpatient setting.

Main Methods:

• Retrospective chart review of male patients treated with nitrofurantoin from January 2004 to July 2013.
• Statistical analyses, including bivariate and multivariate models, were used to identify factors impacting clinical cure.

Main Results:

• Creatinine clearance (CrCl) and the Gram stain of the causative organism significantly affected treatment effectiveness.
• Each 1 ml/min increase in CrCl correlated with a 1.3% rise in the odds of clinical cure.
• Patients with Gram-negative UTIs achieved an 80% cure rate at a CrCl of approximately 60 ml/min.
• Patients with Gram-positive UTIs required a CrCl near 100 ml/min for an 80% cure rate.
• Adverse event rates were not associated with CrCl levels.

Conclusions:

• Nitrofurantoin's clinical cure rates for UTIs are influenced by both CrCl and the infecting organism's type.
• Adverse events associated with nitrofurantoin did not vary significantly with renal function.
• A minimum CrCl of 60 ml/min is recommended to achieve an 80% cure rate for common urinary pathogens in men.