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Primary care
Single-dose fosfomycin is less effective than 5-day nitrofurantoin in women with uncomplicated urinary tract infection: closing the evidence gap for a new recommendation of an old antibiotic
  1. Ildikó Gágyor
  1. Department for General Practice, Julius-Maximilians-Universitat Wurzburg, Wurzburg, Germany
  1. Correspondence to Professor Ildikó Gágyor, Department for General Practice, Julius-Maximilians-Universitat Wurzburg, Wurzburg 97080, Germany; gagyor_i{at}, igagyor{at}

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Commentary on: Huttner A, Kowalczyk A, Turjeman A, et al. Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial. JAMA. 2018; 319:1781–1789.


Uncomplicated urinary tract infection (UTI) is one of the most common indications for prescribing antibiotics in primary care. Although UTI is often self-limiting, most guidelines recommend antibiotics as the first-line treatment. Symptomatic treatment with pain killers has also been proven to be effective in women with uncomplicated UTI, even though this treatment strategy was still non-inferior to antibiotics.1–3 With increasing antibiotic resistance of UTI bacteria, determining the choice of the most effective and least harmful antibiotics has become crucial. In this context, antibiotics demonstrating low levels of resistance rates such as nitrofurantoin, pivmecillinam and …

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  • Contributors IG is the only author of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.