Abstract
Objectives: Postmenopausal women with diabetes mellitus (DM) have an increased incidence of urinary tract infections (UTI) compared to women without DM. The aim of this study is to compare recurrence rates of UTI in postmenopausal women with DM after treatment with nitrofurantoin, the agent of first choice following the Dutch guidelines, with two other common prescribed antibiotics trimethoprim and norfloxacin. Methods: We used a PHARMO database with pharmacy dispensing data. A total of 8534 postmenopausal (>55 years) women with DM who received a first course of nitrofurantoin, trimethoprim or norfloxacin were included. The UTI recurrence rates after treatment with these three different antimicrobial agents were compared. Recurrence was defined as a second prescription for nitrofurantoin, trimethoprim or norfloxacin or a first with fosfomycin, amoxicillin, fluoroquinolones, or trimethoprim/sulfamethoxazole between 6 and 30 days after inclusion. Results: Postmenopausal women with DM had significantly more UTI recurrences when they were treated with nitrofurantoin (22.7%) compared to trimethoprim (17.7%) or norfloxacin (14.2%) irrespective of the treatment duration. There was a trend that longer treatment duration was associated with higher recurrence rates. Conclusions: Postmenopausal women with DM had more UTI recurrences when they are treated with nitrofurantoin, agent of first choice, compared to trimethoprim or norfloxacin.
Highlights
Postmenopausal women with diabetes mellitus (DM) have an increased incidence and complication rate of urinary tract infections (UTI) compared to women without DM [1,2,3].As far as we are aware, no randomized trials comparing different antibiotic treatments for UTI in women with DM are present
Postmenopausal women with DM had significantly more UTI recurrences when they were treated with nitrofurantoin (22.7%) compared to trimethoprim (17.7%) or norfloxacin (14.2%) irrespective of the treatment duration
Patients using: N (%) nitrofurantoin N (%) trimethoprim N (%) norfloxacin with DM had more UTI recurrences when they were treated with nitrofurantoin, the first choice agent, compared to trimethoprim or norfloxacin, irrespective of the treatment duration
Summary
Postmenopausal women with diabetes mellitus (DM) have an increased incidence and complication rate of urinary tract infections (UTI) compared to women without DM [1,2,3]. As far as we are aware, no randomized trials comparing different antibiotic treatments for UTI in women with DM are present. Because of the possible severity of UTI in patients with DM international guidelines recommend prolonged treatment with specific antimicrobial agents in these patients. Most recommendations rely on expert’s opinions [4]. The aim of this study is to compare recurrence rates of UTI in postmenopausal women with DM after treatment with nitrofurantoin, the agent of first choice following the Dutch guidelines with trimethoprim and norfloxacin which are frequently used
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