Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women
Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women
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DOI：
10.1503/cmaj.150067
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发表时间：
2015-06-16
影响因子：
14.6
通讯作者：
Garg, Amit X.
中科院分区：
文献类型：
--
作者：
Singh, Namisha;Gandhi, Sonja;Garg, Amit X.
背景：抗生素呋喃妥因通常用于治疗简单的尿路感染。然而，当肾功能下降的患者使用该药物时，其尿液浓度可能低于治疗水平。 方法：我们对加拿大安大略省的老年女性（平均年龄 79 岁）进行了一项基于人群的研究，她们的估计肾小球滤过率相对较低（中位值 38 mL/min 每 1.73 m(2)），并且为她们开了 4 种抗生素中的 1 种治疗尿路感染：呋喃妥因、环丙沙星、诺氟沙星或甲氧苄氨嘧啶-磺胺甲恶唑。我们评估了随后 14 天内治疗失败的 2 项指标：接受针对尿路感染的第二种抗生素以及因尿路感染住院（急诊科就诊或入院）。我们对估计肾小球滤过率相对较高的老年女性（中位值 69 mL/min/1.73 m(2)）重复进行了分析。结果：4 个抗生素组的基线特征相似。相对于呋喃妥因，其他抗生素（包括环丙沙星）在估计肾小球滤过率相对较低的女性中与较低的治疗失败率相关（环丙沙星与呋喃妥因：第二个抗生素处方，130/1989 [6.5%] vs. 516/3739 [13.8%]，比值比 [OR] 0.44，95% 置信区间[CI] 0.36-0.53；医院遭遇，21/1989 [1.1%] vs. 95/3739 [2.5%]，OR 0.41，95% CI 0.25-0.66）。然而，在估计肾小球滤过率相对较高的女性中也观察到呋喃妥因治疗失败的类似风险。多项附加分析的结果是一致的。解释：在这项研究中，估计肾小球滤过率轻度或中度降低并不能证明避免呋喃妥因。
Background:The antibiotic nitrofurantoin is commonly used to treat uncomplicated urinary tract infections. However, when this drug is used by patients with reduced kidney function, its urine concentration may be subtherapeutic.Methods:We conducted a population-based study of older women (mean age 79 years) in Ontario, Canada, whose estimated glomerular filtration rate was relatively low (median 38 mL/min per 1.73 m(2)) and for whom 1 of 4 antibiotics had been prescribed for urinary tract infection: nitrofurantoin, ciprofloxacin, norfloxacin or trimethoprim-sulfamethoxazole. We assessed 2 measures of treatment failure in the subsequent 14 days: receipt of a second antibiotic indicated for urinary tract infection and hospital encounter (emergency department visit or hospital admission) with a urinary tract infection. We repeated the analysis for older women with relatively high estimated glomerular filtration rate (median 69 mL/min per 1.73 m(2)).Results:The baseline characteristics of the 4 antibiotic groups were similar. Relative to nitrofurantoin, the other antibiotics (including ciprofloxacin) were associated with a lower rate of treatment failure among women with relatively low estimated glomerular filtration rate (for ciprofloxacin v. nitrofurantoin: second antibiotic prescription, 130/1989 [6.5%] v. 516/3739 [13.8%], odds ratio [OR] 0.44, 95% confidence interval [CI] 0.36-0.53; hospital encounter, 21/1989 [1.1%] v. 95/3739 [2.5%], OR 0.41, 95% CI 0.25-0.66). However, a similar risk of treatment failure with nitrofurantoin was also observed among women with relatively high estimated glomerular filtration rate. The results were consistent in multiple additional analyses.Interpretation:In this study, the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin.