Modified-release nitrofurantoin in uncomplicated urinary tract infection

Uncomplicated urinary tract infection (UTI) is the most common bacterial infection presenting in the community ( Platt and Keating, 2007 ). UTIs can cause unpleasant and distressing symptoms and, occasionally, have serious consequences. Nevertheless, uncomplicated UTIs are eminently suitable for community management. Short courses of nitrofurantoin or trimethoprim—the firstline antibiotics—resolve more than 80% of UTIs ( Hummers-Pradier and Kochen, 2002 ). Modified-release nitrofurantoin should be associated with higher levels of compliance than conventional formulations of nitrofurantoin ( Claxton et al. 2001 ). Furthermore, despite entering the UTI armamentarium in 1953 ( Guay, 2001 ), nitrofurantoin resistance does not seem to have changed ( Kahlmeter, 2003 ; Nicolle et al, 2006 ). In contrast, resistance to trimethoprim may be rising to levels that may compromise the antibiotic's firstline position in UTI management ( Hummers-Pradier and Kochen, 2002 ). Against this background, modified-release nitrofurantoin is a suitable alternative—and is arguably preferable—to trimethoprim for the treatment of uncomplicated UTIs.