Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI). Journal Article

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Authors: Chew, AB; Suda, KJ; Patel, UC; Fitzpatrick, MA; Ramanathan, S; Burns, SP; Evans, CT
Article Title: Long-term prescribing of nitrofurantoin for urinary tract infections (UTI) in veterans with spinal cord injury (SCI).
Abstract: CONTEXT/OBJECTIVE: To evaluate the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI. DESIGN: Matched pairs study. SETTING: Veterans cared for at VA facilities from 10/1/2012-9/30/2013. PARTICIPANTS: Veterans. INTERVENTIONS: n/a. OUTCOMES MEASURES: UTI, positive urine cultures, resistant cultures. METHODS: Cases receiving long-term nitrofurantoin (=90 days supply) were matched to controls by facility. Controls were patients who did not receive long-term nitrofurantoin with a history of =3 positive urine cultures and at least one diagnosis of UTI or asymptomatic bacteriuria in the previous year. RESULTS: 122 SCI cases were identified and matched to 196 controls. After adjusting for differences in baseline demographic characteristics, UTIs were less frequent in cases (OR?=?0.60 [95% CI 0.44-0.72]). Cases had a greater mean number of days between positive urine cultures as compared to controls (0.0001). Cases were more likely to have isolates resistant to nitrofurantoin (P?=?0.0001); however, the frequency of multi-drug resistant organisms isolated from the urine was not significantly different. CONCLUSIONS: Long-term prescription of nitrofurantoin may reduce UTIs in veterans with SCI and there is no evidence that it promotes multi-drug resistance. Future prospective studies should be conducted prior to incorporating routine use of long-term nitrofurantoin into clinical care.
Journal Title: The journal of spinal cord medicine
ISSN: 1079-0268; 1079-0268
Publisher: Unknown  
Date Published: 2018