Singh Namisha, Gandhi Sonja, McArthur Eric, Moist Louise, Jain Arsh K, Liu Aiden R, Sood Manish M, Garg Amit X
Division of Nephrology, Department of Medicine (Singh, Gandhi, McArthur, Moist, Jain, Liu, Garg), and the Department of Epidemiology and Biostatistics (Gandhi, Moist, Liu, Garg), Western University, London, Ont.; Institute for Clinical Evaluative Sciences (McArthur, Moist, Jain, Garg), Toronto, Ont.; The Ottawa Hospital Research Institute (Sood), University of Ottawa, Ottawa, Ont.
CMAJ. 2015 Jun 16;187(9):648-656. doi: 10.1503/cmaj.150067. Epub 2015 Apr 27.
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.
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)).
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.
In this study, the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin.
抗生素呋喃妥因常用于治疗非复杂性尿路感染。然而，肾功能减退的患者使用该药物时，其尿液浓度可能达不到治疗水平。
我们在加拿大安大略省对老年女性（平均年龄79岁）进行了一项基于人群的研究，这些女性的估计肾小球滤过率相对较低（中位数为38 mL/（min·1.73 m²）），且因尿路感染被开具了以下4种抗生素中的一种：呋喃妥因、环丙沙星、诺氟沙星或甲氧苄啶-磺胺甲恶唑。我们评估了随后14天内治疗失败的2项指标：接受第二种针对尿路感染开具的抗生素治疗以及因尿路感染而就医（急诊就诊或住院）。我们对估计肾小球滤过率相对较高（中位数为69 mL/（min·1.73 m²））的老年女性重复了该分析。
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相比：第二种抗生素处方，130/1989 [6.5%] 比 516/3739 [13.8%]，比值比 [OR] 0.44，95%置信区间 [CI] 0.36 - 0.53；就医，21/1989 [1.1%] 比 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，也观察到使用呋喃妥因时治疗失败的风险相似。多项额外分析的结果一致。
在本研究中，估计肾小球滤过率轻度或中度降低并不意味着应避免使用呋喃妥因。
