title: Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis.
abstract: OBJECTIVE
  To analyze the costs of nitrofurantoin use compared to those of other antibiotics recommended for treatment of uncomplicated urinary tract infection (UTI).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Infectious Disease Clinical Outcome Research Unit (IDCORE), Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90509, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: McKinnell
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Stollenwerk
authors.forename: Chin W
authors.initials: CW
authors.lastname: Jung
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000191:economics* / Q000627:therapeutic use*; D015986:Confounding Factors, Epidemiologic; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003556:Cystitis / Q000188:drug therapy / Q000191:economics; D003661:Decision Support Techniques; D003663:Decision Trees; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009582:Nitrofurantoin / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D012107:Research Design; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics / Q000627:therapeutic use; D014481:United States; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000191:economics*
chemical_list: D000892:Anti-Infective Agents, Urinary; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D009582:Nitrofurantoin