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Nitrofurantoin Failure in Elderly Men: A Retrospective Observational Study
Ilse Wolterink1, Theo Verheij1, Tamara Platteel1
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, Universiteitsweg 100, 3508 GA Utrecht, The Netherlands.
Antibiotics (Basel, Switzerland)
|May 1, 2020
Summary
Nitrofurantoin treatment for urinary tract infections (UTIs) in elderly men frequently fails. This study found male gender and older age increase the risk of nitrofurantoin failure in older adults.
Area of Science:
- Geriatrics
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are prevalent in the elderly population.
- Nitrofurantoin is a common antibiotic for UTIs, but its efficacy in older men with potential tissue involvement is questioned.
- Treatment failure can lead to complications and necessitates further antibiotic use.
Purpose of the Study:
- To determine the prevalence of nitrofurantoin treatment failure in elderly patients (≥65 years).
- To assess the impact of gender and age on nitrofurantoin failure rates in this demographic.
- To evaluate the appropriateness of nitrofurantoin as a first-line treatment for UTIs in elderly men.
Main Methods:
- Retrospective observational study utilizing a Dutch general practice medical record database.
- Analysis of 3537 first-time nitrofurantoin prescriptions in 2015 among 21,789 men and 26,622 women aged 65 years or older.
- Multivariate logistic regression used to assess the effect of age and gender on treatment failure, defined as a subsequent antibiotic prescription within 30 days.
Main Results:
- Overall nitrofurantoin failure rate was 17% (584/3537 patients).
- Men exhibited a significantly higher failure rate (27%, 135/506) compared to women (15%, 449/3031).
- Male gender (OR=2.09) and increasing age (OR=1.02) were independently associated with increased odds of nitrofurantoin treatment failure.
Conclusions:
- Nitrofurantoin failure is substantial in elderly patients, particularly in men.
- The findings suggest nitrofurantoin may not be an optimal first-choice antibiotic for UTIs in elderly men.
- Reconsideration of nitrofurantoin as a primary treatment for UTIs in this patient group is warranted.
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