Nitrofurantoïne minder effectief bij patiënten met een verminderde nierfunctie*

Objective

We determined the effect of renal function on the chance of therapy failure with use of nitrofurantoin, fosfomycin and trimethoprim for cystitis.

Methods

We obtained retrospective data from Dutch general practices between 2013-2019. Uncomplicated cystitis episodes were included if treated with five days nitrofurantoin (NF5), fosfomycin-trometamol as single-gift (FT1) or three days of trimethoprim (TMP3) in women (>11 years) without risk factors for a complicated course. Complicated cystitis episodes required treatment with seven days nitrofurantoin (NF7) or trimethoprim (TMP7). Treatment failure was defined as a second antibiotic prescription for cystitis or pyelonephritis within 28 days. Logistic regression analysis was applied with adjustment for demographics, comorbidity and medical history.

Results

After adjustment, each renal function decrease of 10 mL/min resulted in significant more treatment failures when using NF5 (adjusted odds ratio:1.05,95%CI:1.01-1.09) and NF7 (aOR:0.05,95%CI:1.02-1.09), but not when using FT1 (aOR 0.96,95%CI: 0.92-1.01), TMP3 (aOR:0.98,95%CI:0.89-1.08) or TMP7 (aOR:1.02,95%CI: 0.93-1.14). In patients with uncomplicated cystitis and eGFR≥60 mL/min, treatment failure occurred in 14.6% when using NF5, 20.7% when using FT1 (aOR versus.NF5:1.37,95%CI:1.18-1.59) and 20.8% when using TMP3 (aOR versus NF5:1.42,95%CI:1.07-1.87). In the population with uncomplicated cystitis and eGFR<60 mL/min, treatment with FT1 resulted in treatment failure in 16.0% and NF5 in 23.3% of patients (aOR:0.61,95%CI:0.39-0.95).

Conclusions

In patients with normal renal function, treatment with fosfomycin or trimethoprim for uncomplicated cystitis is associated with more treatment failure than with nitrofurantoin. In patients with renal impairment, nitrofurantoin is associated with more treatment failures than fosfomycin. Renal function, if known, should be considered in treatment for cystitis.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.