Nitrofurantoin failure in males with an uncomplicated urinary tract infection: a primary care observational cohort study

BACKGROUND: Nitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable. AIM: To compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline. DESIGN AND SETTING: Retrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020. METHOD: Medical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression. RESULTS: Most UTI episodes in males were uncomplicated (n = 6805/10 055 episodes, 68%). Nitrofurantoin was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin (n = 1887, 28%), amoxicillin/clavulanic acid (n = 470, 7%), and trimethoprim/sulfamethoxazole (n = 285, 4%). Antibiotic failure occurred in 25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure. CONCLUSION: Nitrofurantoin failure was common in males with uncomplicated UTI and increased with age.