Division of Infectious Disease Clinical Outcome Research Unit (IDCORE), Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90509, USA.
Mayo Clin Proc. 2011 Jun;86(6):480-8. doi: 10.4065/mcp.2010.0800. Epub 2011 May 16.
To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI).
We used a decision analysis model to perform cost-minimization and sensitivity analyses to determine the level of trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone resistance that would favor the use of nitrofurantoin as a first-line empirical treatment of uncomplicated UTIs. The model used a program perspective to evaluate costs.
Nitrofurantoin was cost-minimizing when the prevalence of fluoroquinolone resistance exceeded 12% among uropathogens or the prevalence of TMP-SMX resistance exceeded 17%. On 2-way sensitivity analysis, variables that had a significant impact on our cost-minimization threshold included cost of antibiotics and probability of clinical cure with antibiotics.
From a payer perspective, nitrofurantoin appears to be a reasonable alternative to TMP-SMX and fluoroquinolones for empirical treatment of uncomplicated UTIs, especially given the current prevalence of antibiotic resistance among community uropathogens. On the basis of efficacy, cost, and low impact on promoting antimicrobial resistance, clinicians should consider nitrofurantoin as a reasonable alternative to TMP-SMX and fluoroquinolones for first-line therapy for uncomplicated UTIs.
分析与推荐用于治疗单纯性尿路感染（UTI）的其他抗生素相比，使用呋喃妥因的成本。
我们使用决策分析模型进行成本最小化和敏感性分析，以确定使呋喃妥因成为治疗单纯性 UTI 的一线经验性治疗药物的复方磺胺甲噁唑（TMP-SMX）和氟喹诺酮耐药水平。该模型采用方案视角评估成本。
当尿路病原体中氟喹诺酮耐药率超过 12%或 TMP-SMX 耐药率超过 17%时，呋喃妥因的成本最小化。在双向敏感性分析中，对我们的成本最小化阈值有重大影响的变量包括抗生素的成本和抗生素临床治愈率的概率。
从支付者的角度来看，鉴于目前社区尿路病原体的抗生素耐药率，呋喃妥因似乎是 TMP-SMX 和氟喹诺酮类药物用于治疗单纯性 UTI 的经验性治疗的合理替代方案。基于疗效、成本和对促进抗菌药物耐药性的低影响，临床医生应考虑将呋喃妥因作为 TMP-SMX 和氟喹诺酮类药物治疗单纯性 UTI 的一线治疗的合理替代方案。
