Study of Nitrofurantoin Susceptibility in Urinary Isolates of E.coli – A Need to Revert Back to Older Drugs

Urinary tract infections have a high incidence in general population, with potential complications and constantly shifting trends in drug resistance that emphasizes the importance of selecting appropriate antimicrobial therapy. The present study shall focus on nitrofurantoin susceptibility in urinary E.coli isolates which heralds shifting trends in drug resistance among uropathogens and emphasizes on the need to revert back to older urinary antimicrobial agents. The study shall serve as an update on the susceptibility of E.coli to various commonly used antibiotics. A retrospective study was conducted by analyzing culture results and antimicrobial susceptibility pattern of E.coli isolated from 4533 urine samples collected from both inpatients and outpatients in Microbiology Department of tertiary care institute from January 2013 to December 2013. E.coli isolates depicted maximum sensitivity to Nitrofurantoin (87.12%) followed by Amikacin (86.53%) and Gentamicin (68.19%) whereas resistance remained high to Cefazolin (86.82%), Norfloxacin (84.53%), Cotrimoxazole (82.23%), Amoxyclav (82.23%) and Ciprofloxacin (76.22%). Nitrofurantoin susceptibility of E.coli isolates remained high in females (90.61%) as compared to males (83.09%). Among inpatients maximum sensitivity to nitrofurantoin was exhibited by isolates recovered from Gynae/obstetrics ward (94.59%) followed by pediatrics ward (82.35%). The study depicts promising use of Nitrofurantoin as narrow spectrum antibiotic to de-escalate the selection pressure and as fluoroquinolones sparing drug in areas where Cotrimoxazole resistance remains high in the uncomplicated cystitis. Clinicians should use local surveillance data to formulate empiric selection of antibiotic therapy in urinary tract infections.