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A hospital-based descriptive cross-sectional study in Eastern India to estimate the effect of nitrofurantoin, an age-old therapeutic option, in uncomplicated urinary tract infection

Background: Urinary pathogens develop lesser resistance against Nitrofurantoin than other antimicrobials such as Fluoroquinolones, Cotrimoxazole, and Carbapenems. 
 
Aim and Objective: The objective of this study was to estimate the sensitivity pattern of the urinary isolates against Nitrofurantoin in uncomplicated Urinary tract infection (UTI). 
 
Materials and Methods: The descriptive cross-sectional study was performed from January 1, 2020, to June 30, 2020, with 759 cases with signs and symptoms of uncomplicated UTI. Aseptically collected midstream urine was inoculated on Nutrient Agar Media, MacConkeys Agar media, and Blood Agar media for bacterial isolation. Antimicrobial susceptibility testing was done by disk diffusion technique on Mueller Hinton Agar (Kirby Bauer technique) as per Clinical Laboratory Standards Institute guidelines. 
 
Results: Out of total of 759 urine samples, in 165 cases bacterial pathogens were isolated (21.73%). Only 17 were resistant to Nitrofurantoin (10.30%) whereas resistance to Fluoroquinolone (Ciprofloxacin) was in 58 isolates (35.15%) and Cotrimoxazole, in 37 isolates (22.42%). Resistance against Carbapenem antibiotics (Imipenem and Meropenem) was found in 29 isolates (17.57%). All the Nitrofurantoin resistant isolates were Gram-negative. Majority of the Nitrofurantoin resistant isolates were Klebsiella pneumonia (8 out of 17, i.e, 47.05%). All Nitrofurantoin resistant isolates were sensitive to Colistin and Tigecycline. Five out of 17 Nitrofurantoin resistant isolates were sensitive to Meropenem and Imipenem (29.41%). The Fischer exact test reveals that Nitrofurantoin is effective against the isolates resistant to Fluoroquinolones, Cotrimoxazole, and Carbapenems. 
 
Conclusion: Nitrofurantoin, even today, remains a good choice for empirical therapy for uncomplicated UTI.