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J Spinal Cord Med. 2019 Jul;42(4):485-493. doi: 10.1080/10790268.2018.1488096. Epub 2018 Jul 9.

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

Author information

1
a Pharmacy Service, Edward Hines, Jr. Veterans Affairs Hospital , Hines , Illinois, USA.
2
b Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. Veterans Affairs Hospital , Hines , Illinois, USA.
3
c Department of Pharmacy Systems, Outcomes, and Policy , University of Illinois at Chicago , Chicago , Illinois, USA.
4
d Department of Medicine , Loyola University Stritch School of Medicine , Maywood , Illinois, USA.
5
e Spinal Cord Injury Service, VA Puget Sound Health Care Service , Seattle , Washington, USA.
6
f Department of Rehabilitation Medicine , University of Washington , Seattle , Washington, USA.
7
g Department of Preventive Medicine and Center for Healthcare Studies , Northwestern University , Chicago , Illinois, USA.

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.

KEYWORDS:

Antibiotic prophylaxis; Nitrofurantoin; Outcome assessment; Physicians; Practice patterns; Spinal cord injuries; Urinary tract infections

PMID:
29985783
PMCID:
PMC6718139
[Available on 2020-07-01]
DOI:
10.1080/10790268.2018.1488096

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