Shafrir Asher, Oster Yonatan, Shauly-Aharonov Michal, Strahilevitz Jacob
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190401, Israel.
Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem 9112001, Israel.
Biomedicines. 2023 Mar 27;11(4):1019. doi: 10.3390/biomedicines11041019.
In this study, we compared the failure rates of fosfomycin and nitrofurantoin for uncomplicated urinary tract infections. We used Meuhedet Health Services' large database to collect data on all female patients, older than 18 years, who were prescribed either antibiotic during 2013-2018. Treatment failure was a composite endpoint of hospitalization, emergency-room visit, IV antibiotic treatment, or prescription of a different antibiotic, within seven days of the initial prescription. Reinfection was considered when one of these endpoints appeared 8-30 days following the initial prescription. We found 33,759 eligible patients. Treatment failure was more common in the fosfomycin group than the nitrofurantoin group (8.16% vs. 6.87%, -value < 0.0001). However, reinfection rates were higher among patients who received nitrofurantoin (9.21% vs. 7.76%, -value < 0.001). Among patients younger than 40 years, patients treated with nitrofurantoin had more reinfections (8.68% vs. 7.47%, value = 0.024). Treatment failure rates were mildly higher in patients treated with fosfomycin, despite having less reinfections. We suggest that this effect is related to a shorter duration of treatment (one vs. five days) and encourage clinicians to be more patient before declaring fosfomycin failure and prescribing another antibiotic.
在本研究中，我们比较了磷霉素和呋喃妥因治疗非复杂性尿路感染的失败率。我们利用梅乌赫德特医疗服务公司的大型数据库，收集了2013年至2018年期间所有18岁以上、被开具这两种抗生素之一的女性患者的数据。治疗失败是一个复合终点，定义为在初始处方后7天内住院、急诊就诊、静脉用抗生素治疗或开具不同抗生素处方。当初始处方后8至30天出现这些终点之一时，考虑为再感染。我们共找到33759名符合条件的患者。磷霉素组的治疗失败比呋喃妥因组更常见（8.16%对6.87%，P值<0.0001）。然而，接受呋喃妥因治疗的患者再感染率更高（9.21%对7.76%，P值<0.001）。在40岁以下的患者中，接受呋喃妥因治疗的患者再感染更多（8.68%对7.47%，P值=0.024）。尽管再感染较少，但接受磷霉素治疗的患者治疗失败率略高。我们认为这种效应与治疗持续时间较短（1天对5天）有关，并鼓励临床医生在宣布磷霉素治疗失败并开具另一种抗生素之前要有更多耐心。
