Nitrofurantoin or Fosfomycin: The better choice for lower urinary tract infection?

Sheema Yousuf; Nazli Hameed

doi:10.53685/jshmdc.v7i1.382

Authors

Sheema Yousuf Shalamar Hospital, Lahore
Nazli Hameed Shalamar Hospital, Lahore

DOI:

https://doi.org/10.53685/jshmdc.v7i1.382

Keywords:

Nitrofurantoin, Fosfomycin, urinary tract infection, clinical and microbiologic response

Abstract

Background: Almost 50%-60% of women have at least one episode of urinary tract infection (UTI) during their lifetime.

Objective: To determine and compare the effectiveness of oral Fosfomycin and nitrofurantoin in women of reproductive age with lower UTIs.

Methods: A quasi-experimental study was conducted in the urogynaecology department of Shalamar Hospital, Lahore, Pakistan, from 4^th September 2024 to 4^th March 2025. A total of 392 females presenting with symptoms of lower urinary tract infection were included. Participants received empirical treatment with either nitrofurantoin (Group A) or Fosfomycin (Group B) orally after providing a baseline urine sample for culture and sensitivity testing. The primary outcome was the assessment of clinical resolution at the first follow-up visit on day 7. The second follow-up visit on day 14 was conducted to assess bacterial eradication. Data were analyzed using SPSS version 21.

Results: Nitrofurantoin use was associated with higher clinical improvement (82% vs. 71%, p=0.016) and bacteriological resolution (91% vs. 84%, p=0.020) compared with Fosfomycin. Diarrhea was the predominant adverse effect reported more frequently with Fosfomycin use (12.7% vs 6.1%, p=0.02). Nitrofurantoin users achieved faster recovery of symptoms when compared with Fosfomycin e.g., dysuria relief in 2.4 vs 3.1 days (p=0.003), urinary frequency decreased in 3.1 vs 4 days (p=0.005), suprapubic pain settled in 2.9 vs 3.5 days (p=0.04), better post-treatment quality of life in 8.8 vs 8.2 days (p=0.009), and greater willingness to reuse the drug in 89% vs 78% (p=0.008).

Conclusion: Nitrofurantoin demonstrated superior clinical and bacteriological efficacy over Fosfomycin, with faster symptom resolution and greater patient satisfaction, supporting its use as the preferred first-line agent for uncomplicated lower UTIs. Fosfomycin remains a viable alternative where adherence is a concern.

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