From the Research
For a male with catheter-associated urinary tract infection (CAUTI), nitrofurantoin is not the preferred first-line agent due to its poor tissue penetration in the prostate and limited effectiveness for upper urinary tract infections. Instead, better first-line options for male CAUTI include fluoroquinolones (such as ciprofloxacin 500 mg twice daily for 7 days) or trimethoprim-sulfamethoxazole (160/800 mg twice daily for 7 days), as these agents achieve better prostatic penetration 1. When considering nitrofurantoin, it is essential to note that it should be avoided in patients with creatinine clearance less than 30 ml/min due to reduced efficacy and increased toxicity risk 2. The most recent and highest quality study on the topic of CAUTI treatment does not specifically address nitrofurantoin dosing, but it highlights the importance of removing or replacing the urinary catheter if it has been in place for more than 2 weeks to improve treatment outcomes 3. Key considerations for treating CAUTI include:
- Removing or replacing the urinary catheter if it has been in place for more than 2 weeks
- Avoiding nitrofurantoin in patients with creatinine clearance less than 30 ml/min
- Using fluoroquinolones or trimethoprim-sulfamethoxazole as first-line options due to their better prostatic penetration
- Being aware of the potential for antibiotic resistance and the need for antimicrobial stewardship 1.