NITROFURANTOIN -Potential drug, to become empirical therapy against urinary tract infections once again (original) (raw)
Related papers
Nitrofurantoin: The Time-Tested Choice in Uncomplicated Urinary Tract Infection
Journal of Evolution of Medical and Dental Sciences
Uropathogenic Escherichia Coli (UPEC) is the leading pathogen that causes community acquired as well as nosocomial uncomplicated urinary tract infection throughout the world. The study was conducted for one year with 2557 clinically suspected cases, both In-patients and Outpatients , to find out the most common pathogenic bacteria to cause uncomplicated urinary tract infection in a tertiary care hospital, also to determine the sensitivity pattern of the leading uropathogens against commonly prescribed antimicrobials in uncomplicated urinary tract infection. Significant bacteriuria was found in 811 cases (31.71%) in this study. Amongst them, Escherichia coli was isolated in 335 (41.3%) cases and female patients outnumbered the male patients (195, i.e. 58%). Enterococcus spp. (110, i.e. 13.56%) heads the list of Gram positive uropathogens (155 cases, i.e. 19.11%). Candida spp. was isolated in 6.16% of total culture positive cases. Most of the isolated Escherichia coli were sensitive to nitrofurantoin (290, i.e. 87%). Majority of the nitrofurantoin sensitive Escherichia coli was found to be resistant to other broad spectrum antimicrobials. Carbapenemase producers was found to be 220 (75.86%) and 255 (87.93%) were Extended Spectrum Beta Lactamase (ESBL) producers. Most (87.93%) of the Escherichia coli isolates were resistant to Fluoroquinolones. Among nitrofurantoin resistant Escherichia coli, sensitivity to carbapenems was only 33.33%. Thus Nitrofurantoin in Urinary Tract Infection may be used as an empirical drug even in the era of super bugs.
Nitrofurantoin in Urinary Tract Infection: Old is Gold
Objective of the study was to find out the Resistogram of the urinary isolates against different commonly prescribed antimicrobials according to CLSI guidelines. Out of total 319 test samples, in 56 cases bacterial pathogens were isolated. Among those 56 isolates only 13 were resistant to Nitrofurantoin (23.21%) where as resistance to Ciprofloxacin was found in 40 isolates(71.42%), resistance against Co-Trimoxazole was found in 27 isolates (48.21%) and surprisingly, resistance against Carbapenem antibiotics (Meropenem) was in 20 isolates (35.71%). Majority of the Nitrofurantoin resistant bacterial isolates were Klebsiella pneumoniae (4 out of 13 i.e, 30.76%). All Nitrofurantoin resistant isolates were sensitive to both Tigecycline and Colistin and the isolated Escherichia coli(two in number) were sensitive to Meropenem also. There were no other therapeutic options like Fluroquinolones or Co-trimoxazole to manage the Nitrofurantoin resistant isolates as all of them were resistant tothem. Thus medical community should think twice before replacing Nitrofurantoin with Fluroquinolones or Co-Trimoxazoles as emperical therapy.
Journal of laboratory Physicians, 2021
Nitrofurantoin is the first-line drug in the treatment of uncomplicated urinary tract infections (UTIs) and its use has increased exponentially in recent years. Objectives This study aims to determine the susceptibility pattern of nitrofurantoin in gram-negative urinary isolates and to evaluate their bacteriological and epidemiological profile along with co-existing resistance to other important urinary antimicrobials. Material and Methods This was a retrospective study conducted in a tertiary care hospital in New Delhi in which 500 gram-negative bacterial urinary isolates were evaluated. Records of antimicrobial susceptibility were reviewed from July to September 2019. Antimicrobial susceptibility was performed using the Kirby-Bauer disk diffusion method on Mueller Hinton agar and interpreted using CLSI 2019. Test for extended spectrum β-lactamase (ESBL) producers was done using double disk approximation test. Statistical Analysis Data analysis was performed using the SPSS windows version 25.0 software. Results Out of total 500 isolates, 20.17% (94) isolates were resistant (R) to nitrofurantoin and 9.01% (42) were found to be intermediate (I). Highest resistance was seen in Klebsiella sp. (44.61%) and Escherichia coli (8.12%). About 28.82% of the I/R isolates were of the pediatrics age group and most of the isolates belonged to females (64.69%). High resistance was also seen against ampicillin (92.30%), cefazolin (88.46%), ceftazidime (73.0%), and fluoroquinolones (65.38%). Carbapenemase co-resistance was seen in 57.15% isolates whereas ESBL production was seen in 30.76% of E. coli and 12.06% of Klebsiella sp. Conclusion Increase in multidrug resistance uropathogens along with a near absence of novel oral antibiotics has led to increased consumption of nitrofurantoin since its resistance has increased.
Role of Nitrofurantoin in the Management of Urinary Tract Infection - A Systematic Review
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Urinary tract infections are often caused by bacteria resistant to antibiotics which have evolved to be a major health issue in recent years. Often, urinary tract infections are very hard to treat and if not appropriately treated in time, may result in serious consequences, particularly, when it spreads to kidneys ultimately resulting in an increase in morbidity and mortality. Nitrofurantoin, a first line agent and has bactericidal action, frequently used to treat uncomplicated urinary tract infection. The literature was searched with published sources from Medline, PubMed and Embase search engines. Published articles were searched, of which 81 articles were eligible to be included for this systematic review. Nitrofurantoin is reduced by the action of bacterial flavoproteins to reactive intermediate compounds that non-specifically inactivate ribosomal proteins resulting in inhibition of protein synthesis. Various mechanisms seem to be responsible for the reduced capability of microorganism to acquire resistance in a faster manner. Nitrofurantoin exhibits high quality success against most bacteria anticipated in urinary tract infection. Nitrofurantoin has been recommended for prophylaxis in the treatment of reinfection in case of recurrent uncomplicated urinary tract infections in many western countries. Nitrofurantoin is one of the treatment options for urinary tract infection due to extended spectrum beta lactamase producing Escherichia coli. In pregnant women with urinary tract infection, nitrofurantoin can be appropriate treatment. Also, nitrofurantoin associated reactions have been reported in many studies. This review updates the clinical use of nitrofurantoin, including new facts about the role of nitrofurantoin in the therapy of community acquired urinary tract infection, adverse outcomes, complications, interactions and antibiotic resistance mechanism against different uropathogens.
Nitrofurantoin Resistance Among Common Urinary Isolates in Uncomplicated Urinary Tract Infection
IOSR Journal of Dental and Medical Sciences, 2016
Despite being a common health problem, community acquired uncomplicated Urinary Tract Infection (UTI) is a bit underrated because of its lower mortality rate, relative ease of diagnosis and easily available oral remedy for it. But ever increasing antibiotic-resistance of the uropathogens has forced us to have another look into this matter. This study is an effort to see whether the less commonly prescribed oral antibiotic like Nitrofurantoin can be a better option for treatment before switching over to the final option of intravenous antibiotic therapy.Mid-stream urine samples were collected from 642 symptomatic UTI patients, out of which, 111 were culture positive. The predominant organism was Escherichia coli, CONS, S. aureus, Klebsiella species. Very high level of resistance was observed against fluoroquinolones, ampicillin, amoxycillin-clavulanic acid, cephalosporins. But, Nitrofuranrtoin resistance was relatively less-21%. The other antibiotics which showed equal or higher level of susceptibility than Nitrofurantion were all injectable preparations-Imipenem, Cefoperazone-sulbactam, Amikacin and Gentamicin. So, in the current scenario, use of Nitrofutantion to treat uncomplicated community acquired UTI should be considered in our state.
Bacterial IsolateProfile in Gram-Negative Urinary Isolates: Role ofNitrofurantoin
International Journal of Human and Health Sciences (IJHHS)
Background: In current times epidemic drug resistance has renewed interest in drugs belonging to the yesteryears, most importantly Nitrofurantoin for urinary tract infections. Studies have reported that more than 90% of urinary tract infections are due to enteric Gram-negative organisms, of which more than 80% are E.coli.Objectives: To study bacterial profile in Gram-negative urinary isolates and evaluate the role of nitrofurantoin.Methods: We retrospectively evaluated 500 consecutive Gram-negative bacterial isolates for bacteriological profile and nitrofurantoin sensitivity of patients of urinary tract infections at a tertiary care facility in India between January and June of 2022.\Results: We had a total of 500 Gram- negative urinary isolates. 383 (76.6%) of these were found to be susceptible to nitrofurantoin. E. coli alone constituted 343 (68.6%) of total 500 Gramnegative isolates, 264 (76.96%) of which were sensitive to nitrofurantoin. 20 (4%) Proteus and 05 (1%) Citrobacter s...
IOSR Journals , 2019
Introduction: Urinary tract infection (UTI) is the most common health problems in the community as well as in nosocomial set up affecting all age groups from Neonates to Geriatric[1,7]. Widespread use of antibiotics for these highly predictable susceptibility pattern of the common uropathogens has led to the emergence of resistant microorganisms [5]. Nitrofurantoin,a Nitrofuran antimicrobial is a cost effective, well tolerated,oral broad-spectrum bactericidal antibiotic .It acts at multiple site hence is effectively used to treat urinary tract infections (UTIs) caused by E. coli, Klebsiella sp., Enterobacter sp., Enterococcus sp. and Staphylococcus aureus.[4]. But most Proteus species,Serratia marcescens,Morganella morgagni, Pseudomonas species and Acinetobacter species are naturally resistant[2,9].Unfourtunately Nitrofurantoin is an underused antimicrobial agent for empirical therapy for community acquired and nosocomial lower UTIs. Hence this study was undertaken to assess the effect of Nitrofurantoin currently against the gram-positive and gram-negative uropathogens. Materials & Methods: A Crosssectional study was done for one year period (Jan2017-Dec2017)in a tertiary care hospital. A clean catch mid stream urine collected in proper sterile manner were inoculated in CLED agar and incubated at 37 0 C for 18-24hrs.The Antibiotic susceptibility testing for the identified uropathogens by standard methodology was done by Kirby Bauer Disc Diffusion Method. The reports of positive urine culture and zone diameter of inhibition of <14mm of uropathogens to Nitrofurantoin were recorded for E.coli,Klebsiella species,Citrobacter species,Enterobacter species,Staphylococcus aureus,CONS and Enterococcus species. Phenotypic screening for different beta-lactamase producers like extended spectrum beta-lactamases ,Carbapenem resistant Enterobactericaea, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCONS) were also recorded. Results: Out of 15918 urine samples received and processed ,2880 sample showed growth of uropathgens.Among the isolates,E.coli 1288 (44.7%) was the most common followed by Klebsiella species 658(22.8%) and Enterococcus species 311(10.79%).The Antibiotic susceptibility pattern of the isolates to Nitrofurantoin among the GNB were E.coli 91%,Klebsiella species 78%,Citrobacter species 69% and among GPC, Enterococcus species 93%,Staphylococcus aureus and CONS 100%.Moreover ESBL producing uropathogens were E.coli 519(40%),Klebsiella species 241(36%),Citrobacter species 28(45%). Carbapenem resistant Enterobactericiae were E.coli 105(8.1%),Klebsiella species30(4.5%) and Citrobacter species 3(4.8%). Among the GPC ,MRSA 7(41%) and MRCONS 26(53%). However ESBL producing E.coli 404(77%),Klebsiella species 97(40%) and Citrobacter species 9(32%) and Carbapenem resistant Enterobactericiae mainly E.coli 10(9%) were susceptible to Nitrofurantoin. Among the Gram Positive cocci all the MRSA and MRCONS were 100% susceptible to Nitrofurantoin.
The New Journal of Medicine, 2012
Objective: In this retrospective study, we aimed to detect the in vitro efficacy of nitrofurantoin and commonly used antibiotics in the treatment of urinary tract infections (UTIs) that are caused by Escherichia coli. Material and method: A total of 3,279 urine isolates of E.coli [2,157 (65.8%) outpatients, 1,122 (34.2%) inpatients] were included in this study. Identifications of E.coli isolates were performed by conventional methods and the BD PhoenixTM 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility tests were examined with Kirby-Bauer’s disc diffusion method. The double-disk synergy method was used for the detection of extanded-spectrum betalactamase (ESBL) activity. Results: The susceptibility rates for amoxicillinclavulanate, trimetoprim-sulfametoksazol, and ciprofloxacin were detected as 22.2%, 39.8%, and 41.1%, respectively. Nitrofurantoin susceptibility rate was 93.1% (n=2,009) in outpatients and 89.2% (n=1,001) in inpatients. The difference among nitrofurantoin susceptibility rates of outpatients and inpatients was statistically significant (p<0.001). But, there was no statistically significant relationship between the nitrofurantoin susceptibility and distribution according to the years of susceptibility rate (p=0.755). The rate of ESBL-producing E.coli isolates was detected as 38% (n=1,246). There was also statistically significant difference between ESBL-producing and ESBL-nonprocuding isolates for nitrofurantoin susceptibility rates (p<0.001). Conclusion: In the light of present study, we consider that nitrofurantoin may be used safely for the therapy of UTIs at least in our hospital. Key Words: Urinary tract infections; Escherichia coli; nitrofurantoin; antibiotics; microbial sensitivity test