NEW YORK (Reuters Health) Dec 30 - In the wake of growing bacterial resistance to fluoroquinolones and increasing use of these agents for urinary tract infections (UTIs), a paper in the December issue of BJU International argues that "an old friend" nitrofurantoin should become the first-line therapy of choice.
Dr. James Kashanian and colleagues at the Maimonides Medical Center in Brooklyn, New York, reviewed antimicrobial susceptibility patterns of urinary isolates obtained between 2003 and 2007.
Overall, they say, 10,417 cultures from that period grew Escherichia coli, and 95.18% of E. coli isolates were susceptible to nitrofurantoin, with an average resistance rate of 2.3%.
In contrast, susceptibility rates for the E. coli isolates to ciprofloxacin and levofloxacin were 75.6% and 75.9%, respectively, and resistance rates were 24.2% to ciprofloxacin, 24% to levofloxacin, and 29% to trimethoprim/sulfamethoxazole.
"The broad range of bactericidal action of nitrofurantoin explains the relative lack of accumulated resistance to the drug over the past 50 years," the researchers write.
The investigators conclude, on the basis of their own data and similar reports by others, "that nitrofurantoin might be extremely effective in treating uncomplicated urinary tract infections. The lower cure rates and the increasing resistance associated with ciprofloxacin and levofloxacin should no longer make quinolones the first choice for treatment."
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