Failure Rate of Oral Nitrofurantoin in Treating UTIs caused by ESBL-Producing Escherichia coli and Klebsiella pneumoniae : A Retrospective Cohort Study
Background: Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms limit oral treatment options. Nitrofurantoin is frequently used, but regional data on its activity against ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP)...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Riyadh Second Health Cluster Research Center, King Fahad Medical City (KFMC)
2025-08-01
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| Series: | The Journal of Medicine, Law & Public Health |
| Subjects: | |
| Online Access: | https://jmlph.net/index.php/jmlph/article/view/233 |
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| Summary: | Background:
Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms limit oral treatment options. Nitrofurantoin is frequently used, but regional data on its activity against ESBL-producing Escherichia coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP) are lacking in Saudi Arabia. This study aimed to determine the 90-day failure rate of oral nitrofurantoin in treating ESBL-UTIs and explore secondary outcomes.
Methods:
This was a retrospective cohort study conducted at a tertiary hospital in Riyadh, Saudi Arabia. The target population was adult ED patients, discharged on oral nitrofurantoin for UTIs caused by ESBL-EC or ESBL-KP, between February 2021 and June 2024. We aimed to identify the failure rate of oral nitrofurantoin in this population. Treatment failure was defined as any ESBL-positive urine culture within 90 days of treatment initiation.
Results:
Among 13,421 UTI cases, 347 (2.6%) were ESBL-positive; 41 received oral nitrofurantoin, and 18 met the final inclusion criteria. The 90-day recurrence rate was 22.2% (4/18), with 77.8% having no early recurrence. Three patients had recurrence between 90–180 days. Half of all nitrofurantoin-treated patients were later hospitalized, with severe cases requiring ICU.
Conclusion:
Nitrofurantoin showed a 22% failure rate in treating ESBL-UTIs, yet remained effective in most cases, especially those involving ESBL-EC. Given its accessibility, nitrofurantoin remains a viable option but requires close follow-up. Larger studies are needed to refine its role in ESBL-UTI management.
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| ISSN: | 2788-9815 2788-791X |