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Multicenter Study
. 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)

Alexander B Chew  1 , Katie J Suda  2   3 , Ursula C Patel  1 , Margaret A Fitzpatrick  2   4 , Swetha Ramanathan  2 , Stephen P Burns  5   6 , Charlesnika T Evans  2   7
Affiliations
Multicenter Study

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

Alexander B Chew et al. J Spinal Cord Med. 2019 Jul.

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.

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Figures

Figure 1
Figure 1
Selection of the case and control groups.
See this image and copyright information in PMC

References

    1. NINDS Spinal Cord Injury: Hope Through Research. July 2013. http://www.ninds.nih.gov/disorders/sci/detail_sci.htm?css=print. Accessed October 12, 2014.
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