Clinical Effectiveness and Bacteriological Eradication of 4 Short-course Antibiotics for Uncomplicated UTIs in Women.

Inclusion Criteria: Women of 18 years of age or older, with clinical features of uncomplicatedcommunity-acquired lower urinary tract infection including:

• At least one of four key symptoms of lower urinary tract infection: dysuria, urgencyincluding nycturia, frequency, and suprapubic tenderness that could be attributed toan uncomplicated lower urinary tract infection, and no alternative explanation (i.e.symptoms suggestive of sexually-transmitted infection or vulvovaginitis), and
• A urine dipstick analysis positive for either nitrites or leukocyte esterase.

Exclusion Criteria:

• Male sex
• High suspicion of pyelonephritis (i.e. fever ≥ 37.5°C or flank pain/tenderness)
• Any condition that may lead or predispose to complicated urinary infection (i.e.indwelling urinary catheter, pregnancy, immunosuppressive therapy, abnormal urinarytracts, recurrent urinary tract infection, severe neurological disease affecting thebladder)
• Pregnancy or planned pregnancy
• Symptoms consistent with urinary tract infection in the preceding 4 weeks
• Patients taking long-term antibiotic prophylaxis
• Ongoing antibiotic therapy or use of any systemic antibiotic in the previous 7 days
• Symptoms correlating with differential diagnosis (i.e. vaginal discharge or pain)
• Hypersensitivity or allergy to β lactams, nitrofurantoin and/or fosfomycin
• Moderate to severe chronic renal insufficiency
• Pre-existing polyneuropathy
• History of lung or liver reaction or peripheral neuropathy after previous use ofnitrofurantoin
• Glucose-6-phosphate dehydrogenase deficiency
• Porphyria or systemic primary carnitine deficiency or of the type organic aciduria (i.e. methylmalonic aciduria and propionicacidaemia)
• Esophageal stricture
• Current intake of allopurinol or probenecid or valproate
• Currently part of another randomized clinical trial
• Previous enrolment in the proposed study
• Patients living in long-term institutions; and/or
• Difficulty in conducting scheduled follow-up visits