Presentation Authors: Navin Maredia*, Bonnie C Prokesch, Michael Fanning, Alana Christie, Philippe Zimmern, Dallas, TX
Introduction: Nitrofurantoin (NF) is used to treat recurrent urinary tract infections (RUTI). Despite minimal data, the Beers criteria has cautioned against long-term use of NF in geriatric patients. This study reviews the safety and efficacy of chronic suppressive therapy with NF in neurogenic (NG) and non-neurogenic (NN) post-menopausal women.
Methods: A query of the electronic medical record at a tertiary care institution yielded 11,200 charts of women aged 50-95 prescribed NF by over 75 providers from 2006-2018 in outpatient clinics. Charts from primary urology providers prescribing NF therapy for at least 3 consecutive months were further analyzed. Demographics, reason for initiation of NF, dose, duration, explanation of therapy interruptions, resistance, occurrence of adverse, comorbid conditions, urine culture, and relevant lab and imaging results were recorded. Start and stop dates of chronic suppressive therapy were tallied from the medication lists and cross-referenced with documentation by the provider for accuracy. Number of months on chronic suppressive therapy were summed.
Results: Of the 221 patients included, 167 (77%) were prescribed 100mg of NF. The most common indication for chronic NF therapy was RUTI prophylaxis. 104 (47%) patients developed cultures resistant to NF but only 4 were switched to an alternative suppressive therapy. 88 (40%) patients developed breakthrough UTI but only 10 were not restarted on NF (4 patients due to NF resistance). NG patients had a higher occurrence of catheter use (p=0.0008) but NN patients had an increased incidence of breakthrough UTI (p=0.0134). There was no difference in resistance rates between NG and NN groups (p=0.4361). No patients developed neuropathy, 1 developed liver dysfunction after 3.5 years of therapy, and 4 developed pulmonary symptoms after a mean use of NF for 3.5 years. None who developed chronic cough had chronic changes to their x-rays
Conclusions: We conclude that post-menopausal women tolerate chronic NF suppressive therapy well with minimal risk of significant adverse events. NF is a safe and effective in the management of chronic RUTI in this patient population.