Nitrofurantoin Proving Old is Gold? - In the Era of Antibiotic Resistance: A Study in a Tertiary Care Hospital

Abstract

Background: Urinary tract infection represents one of the most common diseases encountered in medical practice today. Due to increasing multidrug resistance in major uropathogens, the therapeutic choices are becoming less. Most uropathogens still relatively susceptible to Nitrofurantoin which makes this drug a good alternative for treatment. This study was undertaken to assess the effect of Nitrofurantoin against the uropathogens. Materials and Methods: This is a prospective study between Jan 2020 to June 2021, undertaken in Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangalore. Standard culture techniques for urine samples were followed. Antibiotic sensitivity test was done by Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standards Institute (CLSI) guidelines. ESBL detection was done by NCCLS phenotypic confirmatory combination disc diffusion method using ceftazidime (30 μg) alone and ceftazidime + clavulanic acid (30 μg/ 10 μg). Results: In our study the most common organism was E.coli 62.5%, followed by Klebsiella spp.13%. The other isolates were Enterococcus 8.6%, Pseudomonas 6.8%, Proteus-2.4%, Acinetobacter 2.0%, Citrobacter1.8%, Coagulase negative staphylococci 1.7% and Candida1.2%. The antibiotic sensitivity pattern of the isolates to nitrofurantoin among GNB was E.coli 90.3%, Klebsiella spp. 62.2%, Citrobacter 87.7% and among GPCs, Coagulase negative Staphylococci(CONS) 98.4% and Enterococcus 94.2%. Among E.coli 91.6% of Non ESBL E.coli and 88.6% of ESBL E.coli were sensitive to Nitrofuantoin. Among Klebsiella spp.63.5% of non ESBL Klebsiella and 59.8% of ESBL Klebsiella were sensitive to Nitrofurantoin.