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

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2018.1488096 · Published: January 1, 2019

Spinal Cord Injury Pharmacology Immunology

Simple Explanation

This study looks at whether long-term use of the antibiotic nitrofurantoin can help prevent urinary tract infections (UTIs) in veterans who have spinal cord injuries (SCI). UTIs are a common problem for people with SCI. The researchers compared veterans with SCI who were prescribed nitrofurantoin for a long time to those who were not, looking at how often they got UTIs, positive urine cultures, and antibiotic-resistant infections. The study found that long-term nitrofurantoin use might reduce the number of UTIs in this group, but it also increased the chance of developing bacteria that are resistant to nitrofurantoin. The study suggests more research is needed.

Study Duration

1 Year

Participants

122 SCI cases and 196 controls, veterans

Evidence Level

Matched pairs study

Key Findings

1
UTIs were less frequent in cases receiving long-term nitrofurantoin compared to controls.
2
Cases had a greater mean number of days between positive urine cultures as compared to controls.
3
Cases were more likely to have isolates resistant to nitrofurantoin; however, the frequency of multi-drug resistant organisms isolated from the urine was not significantly different.

Research Summary

This study evaluated the impact of long-term nitrofurantoin for UTI prophylaxis in veterans with SCI. 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.

Practical Implications

Potential UTI Reduction

Long-term nitrofurantoin may reduce UTI occurrence in veterans with SCI.

Increased Nitrofurantoin Resistance

Long-term use is associated with an increased risk of nitrofurantoin-resistant isolates.

Need for Further Research

Prospective studies are needed before routine incorporation into clinical practice.

Study Limitations

1
ICD-9 coding may have resulted in over- or under-representation of UTIs/symptoms.
2
There may be unmeasured factors influencing these results.
3
Veterans may not be representative of the SCI population in the private sector.

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