Can We Still Trust Single-Dose Fosfomycin for Uncomplicated UTI?

Nitrofurantoin and fosfomycin are both guideline-recommended for the management of uncomplicated urinary tract infection (UTI), but a previous randomized trial showed that single-dose fosfomycin was less effective than nitrofurantoin. Now, we have a second randomized trial comparing the two agents as well as pivmecillinam, which was only recently approved in the United States but is also guideline-recommended.

The open-label, multicenter trial involved 720 women in Spain (median age, 48) presenting to primary care with symptoms of uncomplicated UTI and dipstick testing positive for nitrites or leukocyte esterase.