In our study, we investigated the amounts excreted in the bladder of nitrofurantoin and fosfomycin-trometamol to determine whether these two antibiotics are currently being used optimally in daily clinical practice in the treatment of cystitis. We were curious about this because clinical practice shows that not every patient suffers from cystitis after treatment with one of the two drugs.

With this research we want to optimize the effectiveness of the treatment and we also focussed on the prevention of resistance to nitrofurantoin and fosfomycin among microorganisms.

We concluded that there are very large differences between the amounts of antibiotics in the urine between patients and that the patient's urinary rhythm has a major influence. It seems that the amount of antibiotic in the bladder decreases when one goes to the toilet more often. This would, in theory, have an unfavourable effect on the effectiveness of the treatment. Treatment failure with fosfomycin appears to be more related to the resistance of microorganisms while the failure of therapy with nitrofurantoin is more related to low levels of the drug in the bladder. The mechanism of absorption into the blood and excretion into the bladder of nitrofurantoin is complex because it cannot be directly predicted based on the administered dose. More research is needed to investigate this mechanism so that this knowledge can be used to minimize the chance of treatment failure.

, , ,
J.W. Mouton (Johan) , T. van Gelder (Teun) , B.C.P. Koch (Birgit)
Erasmus University Rotterdam
The studies presented in this thesis were supported by the European Commission FP7 AIDA project (Preserving old antibiotics for the future, Health-F3-2011-278348, University of Queensland, and Monash University Melbourne.

Wijma, R.A. (2019, December 10). Pharmacokinetic Profiling of Fosfomycin and Nitrofurantoin to Optimize the Treatment of Uncomplicated Urinary Tract Infections. Erasmus University Rotterdam. Retrieved from

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119946_Chapter_1-Introduction_and_outline.pdf Final Version , 1mb
119946_Chapter_2_1-High_interindividual_variability_in_ur.pdf Final Version , 876kb
119946_Chapter_2_2-A_fast_and_sensitive_LC-MS_MS_method_f.pdf Final Version , 953kb
119946_Chapter_3_1-Review_of_the_pharmacokinetic_properti.pdf Final Version , 1mb
119946_Chapter_3_2-Optimizing_dosing_of_nitrofurantoin_fr.pdf Final Version , 1mb
119946_Chapter_3_3-The_pharmacokinetics_of_nitrofurantoin.pdf Final Version , 962kb
119946_Chapter_3_4-The_urinary_pharmacokinetics_of_nitrof.pdf Final Version , 827kb
119946_Chapter_3_5-Development_and_validation_of_a_fast_a.pdf Final Version , 918kb
119946_Chapter_4_1-Urinary_antibacterial_activity_of_fosf.pdf Final Version , 1mb
119946_Chapter_5_1-The_effectiveness_of_nitrofurantoin-_f.pdf Final Version , 878kb
119946_Chapter_5_2-An_audit_of_nitrofurantoin_use_in_thre.pdf Final Version , 787kb
119946_Chapter_6-Summary-_discussion_and_perspectives.pdf Final Version , 780kb

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