Five versus seven days of nitrofurantoin for urinary tract infections in women with diabetes: a retrospective cohort study

Kelly D Hendriks-Spoor,Floor L Wille,Thijs Ten Doesschate,Julia W Dorigo-Zetsma,Theo J.M Verheij,Cornelis H Van Werkhoven

doi:10.1016/j.cmi.2021.06.034

Abstract

ObjectiveTo compare the effectiveness of 5 versus 7 days of nitrofurantoin treatment for urinary tract infection (UTI) in women with diabetes. MethodsData were collected retrospectively from Dutch general practitioners between 2013 and 2020. Nitrofurantoin prescriptions with a duration of 5 days (5DN) or 7 days (7DN) in women with diabetes were included. Inverse propensity weighting was performed to calculate adjusted risk differences (RD) for treatment failure within 28 days. Secondary outcomes were 14-day treatment failure, severe treatment failure and 28-day treatment failure in defined risk groups. ResultsNitrofurantoin was prescribed in 6866 episodes, 3247 (47.3%) episodes with 5DN and 3619 (52.7%) episodes with 7DN. Patients in the 7DN group had more co-morbidities, more diabetes-related complications and were more insulin-dependent. There were 517/3247 (15.9%) failures in the 5DN group versus 520/3619 (14.4%) in the 7DN group. The adjusted RD for failure within 28 days was 1.4% (95% CI –0.6 to 3.4). ConclusionWe found no clinically significant difference in treatment failure in women with diabetes with UTI treated with either 5DN or 7DN within 28 days. A 5-day treatment should be considered to reduce cumulative nitrofurantoin exposure in DM patients.

Highlights

Urinary tract infections (UTI) are the most common infections in patients with diabetes mellitus (DM) [1]
Episodes from patients with a complicated UTI based on risk factors other than DM were excluded from the database, e.g. pregnancy, use of immunosuppressive drugs, kidney or bladder disease, an estimated glomerular filtration rate below 30 mL/min or three or more recurrent UTI in the last 6 months or prophylactic treatment in the last 6 months
A total of 14 352 nitrofurantoin prescriptions in individuals with DM were found during the study period

Summary

Introduction

Urinary tract infections (UTI) are the most common infections in patients with diabetes mellitus (DM) [1]. Some guidelines suggest that patients with well-controlled diabetes may be considered to have an uncomplicated UTI [3]. This hypothesis is supported by an observational study in 259 women with DM that found no benefit of longer treatment duration (!5 days of treatment) on the recurrence of UTI within 30 days to 1 year of follow up [4]. The Dutch College of General Practitioners recommends treating UTI in patients with diabetes with 7 days of nitrofurantoin, instead of 5 days as recommended for UTI in healthy women, because of the supposed higher risk of recurrent UTI and complications [5]

Methods

Results

Conclusion