Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis

Mayo Clin Proc. 2011 Jun;86(6):480-8. doi: 10.4065/mcp.2010.0800. Epub 2011 May 16.


Objective: To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI).

Patients and methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents, Urinary / economics*
  • Anti-Infective Agents, Urinary / therapeutic use*
  • Confounding Factors, Epidemiologic
  • Cost Control
  • Cost-Benefit Analysis
  • Costs and Cost Analysis*
  • Cystitis / drug therapy
  • Cystitis / economics
  • Decision Support Techniques*
  • Decision Trees
  • Drug Administration Schedule
  • Drug Resistance, Bacterial
  • Female
  • Fluoroquinolones / economics
  • Fluoroquinolones / therapeutic use
  • Humans
  • Middle Aged
  • Models, Statistical
  • Nitrofurantoin / administration & dosage
  • Nitrofurantoin / economics*
  • Nitrofurantoin / therapeutic use*
  • Practice Guidelines as Topic
  • Research Design
  • Sensitivity and Specificity
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / economics
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • United States
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / economics*


  • Anti-Infective Agents, Urinary
  • Fluoroquinolones
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Nitrofurantoin