Cost effective analysis of tab. nitrofurantoin vs. inj. ceftriaxone as an empirical therapy in patients of urinary tract infection at a tertiary health care centre

Nikhil S. Yadav, Swanand S. Pathak


Background: Urinary tract infections (UTI) are commonly seen in adults, Urinary tract infection and asymptomatic bacteriuria in adults are a significant health care burden. In a developing country it is necessary to minimize the cost of therapy while giving maximum health benefits to the patient. Appropriate antimicrobial selection is clearly important, as treatment failures will increase the cost of care and result in additional morbidity for patients. Empirical treatment of urinary tract infection is common at tertiary health care center, authors conducted a pharmacoeconomic study to evaluate cost effectiveness of the empirical treatment.

Methods: Patients with similar symptoms suffering from UTI were divided into 5 groups with 10 patients in each group. Each group was subdivided into two subgroups with subgroup A having five patients receiving tab nitrofurantoin and subgroup B having 5 patients receiving inj ceftriaxone. Out of the total cost of therapy, percentage of cost attributed to tab nitrofurantoin was compared with inj ceftriaxone. Most cost-effective antibiotic was analysed. Average number of admission days for groups of UTI patients receiving tab nitrofurantoin and inj ceftriaxone were calculated and compared. Group of UTI patients receiving antibiotic with least number of admission days was calculated.

Results: Percentage of cost attributed to Nitrofurantoin therapy out of total cost in urinary tract infection patient was less than percentage of cost attributed to inj Ceftriaxone in all five groups of patients and was found to be statistically significant (p <0.05). However, there was no statistically significant difference in average number of admission (IPD) days between groups of patients receiving tab nitrofurantoin and inj ceftriaxone (p>0.05).

Conclusions: In current study authors found tab nitrofurantoin to be more cost effective than inj ceftriaxone as an empirical therapy in UTI patients.


Cost effectiveness, Nitrofurantoin, Urinary tract infection

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Urinary Tract Infection: Symptoms, Diagnosis, and Treatment. Healthline. 2015. Available at: Accessed 8 September 2018.

Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nature Reviews Microbiol. 2015 May;13(5):269-84.

Epidemiology of urinary tract infections: incidence, morbidity, and economic costs - ScienceDirect. Available at: // Accessed 31 August 2018.

Vallejo-Torres L, Pujol M, Shaw E, Wiegand I, Vigo JM, Stoddart M, et al. Cost of hospitalised patients due to complicated urinary tract infections: a retrospective observational study in countries with high prevalence of multidrug-resistant Gram-negative bacteria: the Combacte-Magnet, Rescuing study. BMJ Open. 2018 Apr 1;8(4):e020251.

Kronenberg A, B├╝tikofer L, Odutayo A, M├╝hlemann K, da Costa BR, Battaglia M, et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: randomised, double blind trial. BMJ. 2017 Nov 8;359:j4784.

Friedland LR, Kulick RM, Biro FM, Patterson A. Cost-effectiveness decision analysis of intramuscular ceftriaxone versus oral cefixime in adolescents with gonococcal cervicitis. Ann Emergency Med. 1996 Mar 1;27(3):299-304.

Huttner A, Kowalczyk A, Turjeman A, Babich T, Brossier C, Eliakim-Raz N, 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 May 1;319(17):1781-9.

Shakti L, Veeraraghavan B. Advantage and limitations of nitrofurantoin in multi-drug resistant Indian scenario. Indian J Med Microbiol. 2015 Oct 1;33(4):477.

Janodia M, Patel A, Udupa N. Pharmacoeconomics and its applications - emerging role in India. Value Health. 2014 Nov 1;17(7):A796.

McKinnell JA, Stollenwerk NS, Jung CW, Miller LG. Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc. 2011 Jun 1;86(6):480-8.

Lin HA, Yang YS, Wang JX, Lin HC, Lin DY, Chiu CH, et al. Comparison of the effectiveness and antibiotic cost among ceftriaxone, ertapenem, and levofloxacin in treatment of community-acquired complicated urinary tract infections. J Microbiol Immunol Infection. 2016 Apr 1;49(2):237-42.

Bosmans JE, Beerepoot MA, Prins JM, ter Riet G, Geerlings SE. Cost-effectiveness of cranberries vs antibiotics to prevent urinary tract infections in premenopausal women: a randomized clinical trial. PloS one. 2014 Apr 4;9(4):e91939.

Huang X, Hartzema AG, Raasch RH, Kauf TL, Norwood GJ. Economic assessment of three antimicrobial therapies for uncomplicated urinary tract infection in women. Clin Therapeutics. 1999 Sep 1;21(9):1578-88.

Price JR, Guran LA, Gregory WT, McDonagh MS. Nitrofurantoin vs other prophylactic agents in reducing recurrent urinary tract infections in adult women: a systematic review and meta-analysis. Am J Obstetr Gynecol. 2016 Nov 1;215(5):548-60.