Brumfitt W, Hamilton-Miller J M
Urinary Infection Clinic, Royal Free Hampstead NHS Trust, and Department of Medical Microbiology, Royal Free Hospital School of Medicine, London, UK.
J Antimicrob Chemother. 1998 Sep;42(3):363-71. doi: 10.1093/jac/42.3.363.
Case records from 219 female patients between 1975 and 1992 who were given long-term prophylaxis (1 year) with nitrofurantoin for the prevention of recurrent urinary infections have been reviewed. Patients' age ranged from 9 to 89 years (median 31-35 years, mode 26-30 years); most (61%) were < 40 years old. The median number of symptomatic episodes in the 12 months immediately before prophylaxis was six (mode 4, mean 6.9). 14.4% of the patients were allergic to an antibiotic, and 23.6% had an imaging abnormality. Three regimens were used: group A (43 patients), 50 mg microcrystalline nitrofurantoin, bd; group B (110 patients), 100 mg macrocrystalline nitrofurantoin (Macrodantin), od; group C (66 patients), 50 mg Macrodantin, od. There were no obvious differences in efficacy between the patient groups (173 assessable patients). The mean incidence of symptomatic episodes decreased 5.4-fold during prophylaxis. Four-fifths of the 43 breakthrough infections (mostly due to Escherichia coli), were caused by nitrofurantoin-sensitive strains. An important finding was that patients with an imaging abnormality responded as well as those with no such abnormalities. In 16% of patients, prophylaxis was not helpful, objectively or subjectively, for no obvious reasons. In most patients where prophylaxis was successful, clinical improvement was maintained for at least 6 months after the end of prophylaxis. Nausea was more common in group A (P < 0.001), as were 'all adverse events'. Of those in group A 25.6% stopped prematurely as a result of an adverse event of any type, compared with 13% of those taking Macrodantin (P < 0.01). Older patients (> 65 years) did not report more adverse events than younger patients. No adverse event was life-threatening. Faecal flora analysis showed neither overgrowth by nitrofurantoin-resistant bacteria nor elimination of sensitive coliforms. Thus, macrocrystalline nitrofurantoin 50 mg at bedtime is appropriate for use in the long-term (12 months) prophylaxis of recurrent urinary infections, in view of its efficacy and favourable safety and tolerability profile. Patients can be managed by their family doctor.
回顾了1975年至1992年间219例接受呋喃妥因长期预防（1年）以防止复发性尿路感染的女性患者的病例记录。患者年龄从9岁至89岁不等（中位数31 - 35岁，众数26 - 30岁）；大多数（61%）年龄小于40岁。预防前12个月内有症状发作的中位数为6次（众数4次，均值6.9次）。14.4%的患者对抗生素过敏，23.6%有影像学异常。使用了三种治疗方案：A组（43例患者），50毫克微晶呋喃妥因，每日两次；B组（110例患者），100毫克大结晶呋喃妥因（麦道欣宁），每日一次；C组（66例患者），50毫克麦道欣宁，每日一次。各患者组之间的疗效无明显差异（173例可评估患者）。预防期间有症状发作的平均发生率下降了5.4倍。43例突破性感染（大多由大肠杆菌引起）中，五分之四是由对呋喃妥因敏感的菌株所致。一个重要发现是，有影像学异常的患者与无此类异常的患者反应相同。16%的患者无论客观还是主观上，预防均无效果，原因不明。在大多数预防成功的患者中，预防结束后临床改善至少维持6个月。恶心在A组更常见（P < 0.001），“所有不良事件”也是如此。A组中有25.6%的患者因任何类型的不良事件而提前停药，相比之下，服用麦道欣宁的患者为13%（P < 0.01）。老年患者（> 65岁）报告的不良事件并不比年轻患者多。没有不良事件危及生命。粪便菌群分析显示，既没有耐呋喃妥因细菌过度生长，也没有敏感大肠菌被清除。因此，鉴于其疗效以及良好的安全性和耐受性，睡前服用50毫克大结晶呋喃妥因适用于复发性尿路感染的长期（12个月）预防。患者可由家庭医生管理。
