Objectives

We evaluated the effect of renal function on clinical failure rates of nitrofurantoin, fosfomycin and trimethoprim for the treatment of cystitis in primary care.

Methods

Data were retrospectively obtained from 78 Dutch general practitioner (GP) practices between 2013 and 2019. Eligible episodes in patients (>11 years) were those requiring 5 days of nitrofurantoin (NF5), single-dose fosfomycin–trometamol (FT1), 3 days of trimethoprim (TMP3) for uncomplicated cystitis, or 7 days of nitrofurantoin (NF7) or trimethoprim (TMP7) for complicated cystitis. Clinical failure was defined as second antibiotic prescription for cystitis or pyelonephritis within 28 days post-prescription. Mixed effects regression analysis was used, with patient and GP practice as random effects and demography, comorbidity, and cystitis history as fixed effects.

Results

Adjusted odds ratios (aORs) for clinical failure per 10mL/min decrease in estimated glomerular filtration rate (eGFR) were 1.05 (95% CI: 1.01–1.09) for NF5 (n = 24,591), 0.96 (95% CI: 0.92–1.01) for FT1 (n = 5359), 0.98 (95% CI: 0.89–1.08) for TMP3 (n = 1064), 1.05 (95% CI: 1.02–1.09) for NF7 (n = 10,628) and 1.02 (95% CI: 0.93–1.14) for TMP7 (n = 831). In uncomplicated cystitis and eGFR ≥60 mL/min, clinical failures occurred in 14.6% (1895/12 980) of NF5-treated, 20.7% (266/1283) of FT1-treated (aOR versus NF5 1.37, 95% CI 1.18–1.59) and 20.8% (66/318) of TMP3-treated patients (aOR 1.42, 95% CI 1.07–1.87 versus NF5). In uncomplicated cystitis and eGFR <60 mL/min, FT1 resulted in 16.0% (39/244) and NF5 in 23.3% clinical failures (110/472), aOR: 0.61, 95% CI: 0.39–0.95).

Conclusions

In eGFR ≥60 mL/min treatment with fosfomycin or trimethoprim for uncomplicated cystitis was associated with more clinical failure than treatment with nitrofurantoin, while in eGFR <60 mL/min nitrofurantoin was associated with more clinical failure than fosfomycin–trometamol. Renal function, if known, should be considered in the clinical decision-making for cystitis treatment.

中文翻译：

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呋喃妥因，磷霉素和甲氧苄氨嘧啶治疗与肾功能有关的膀胱炎的有效性。

目标

我们评估了肾功能对硝基呋喃妥因，磷霉素和甲氧苄啶的临床失败率的影响，以治疗初级保健中的膀胱炎。

方法

数据回顾性地从2013年至2019年间从78位荷兰全科医生（GP）诊所获得。患者（> 11岁）的符合条件的发作是需要5天的呋喃妥因（NF5），单次剂量的磷霉素-曲美他莫（FT1），3天的发作单纯甲氧苄啶（TMP3）用于非复杂性膀胱炎，或呋喃妥因（NF7）或甲氧苄啶（TMP7）用于复杂性膀胱炎的7天。临床失败被定义为处方后28天内针对膀胱炎或肾盂肾炎的第二次抗生素处方。使用混合效应回归分析，将患者和GP实践作为随机效应，将人口统计学，合并症和膀胱炎病史作为固定效应。

结果

估计的肾小球滤过率（eGFR）每下降10mL / min，临床失败的校正比值比（aOR）为1.05（95％CI：1.01–1.09），NF5（n = 24,591），0.96（95％CI：0.92–1.01） ）对于FT1（n = 5359），对于TMP3（n = 1064）为0.98（95％CI：0.89–1.08），对于NF7（n = 10,628）为1.05（95％CI：1.02-1.09）和1.02（95％CI） ：0.93–1.14）（针对TMP7）（n = 831）。在无并发症的膀胱炎和eGFR≥60 mL / min的情况下，经NF5治疗的14.6％（1895/12 980），经FT1治疗的20.7％（266/1283）的临床失败率（aOR与NF5 1.37、95％CI 1.18– （1.59）和20.8％（66/318）的TMP3治疗患者（aOR 1.42，95％CI 1.07-1.87 vs NF5）。在无并发症的膀胱炎和eGFR <60 mL / min的情况下，FT1导致16.0％（39/244）和NF5导致23.3％的临床失败（110/472），aOR：0.61，95％CI：0.39–0.95）。

结论

在eGFR≥60 mL / min的情况下，使用磷霉素或甲氧苄氨嘧啶治疗无并发症性膀胱炎比使用呋喃妥因治疗的临床失败率更高，而在eGFR <60 mL / min的情况下，硝基呋喃妥因的治疗失败率大于磷磷酰胺–曲美他莫。如果知道，在膀胱炎治疗的临床决策中应考虑肾功能。