6/28/23, 11:22 PM Nitrofurantoin vs. fosfomycin in UTI Pathway Feedback Search Clinical Topics Home Studies Nitrofurantoin vs. fosfomycin in UTI Nitrofurantoin vs. fosfomycin in UTI Disease Disease Acute cystitis Acute pyelonephritis Trial question What is the effect of 5-day nitrofurantoin in female patients with uncomplicated UTI? Study design Multi-center Open label RCT Population 513 female patients Inclusion criteria: female patients with uncomplicated UTI Key exclusion criteria: pregnancy and lactation, suspected upper UTI, antibiotic use or any symptoms consistent with UTI in the preceding 4 weeks, indwelling catheter, immunosuppression, ongoing chemotherapy or radiation therapy Interventions N=255 oral nitrofurantoin (100 mg PO TID for 5 days) N=258 oral fosfomycin (single 3 g oral dose) Primary outcome Clinical resolution at 28 days after therapy completion 70.0 % 70 58 52.5 % 35.0 % Significant increase 17.5 % NNH = 8 0.0 % https://web.pathway.md/studies/reclvcrMFLsfzg2UC 1/2 6/28/23, 11:22 PM Nitrofurantoin vs. fosfomycin in UTI Pathway Oral nitrofurantoin Oral fosfomycin Significant increase in clinical resolution at 28 days after therapy completion (70% vs. 58%; ARD 12, 95% CI 4 to 21) Secondary outcomes Significant increase in microbiologic resolution (74% vs. 63%; ARD 11, 95% CI 1 to 20) Significant increase in clinical response at 14 days (75% vs. 66%; ARR 9, 95% CI 1 to 17) Safety outcomes No significant differences in adverse events, including nausea (3% vs. 2%) and diarrhea (1% vs. 1%). Conclusion In female patients with uncomplicated UTI, oral nitrofurantoin was superior to oral fosfomycin with respect to clinical resolution at 28 days after therapy completion. Reference Huttner A, Kowalczyk A, Turjeman A et al. Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA. 2018 May 1;319(17):1781-1789. Open reference URL https://web.pathway.md/studies/reclvcrMFLsfzg2UC 2/2