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The newest guidelines for empirical treatment of women with uncomplicated urinary tract infections (UTIs) advise clinicians to choose among three venerable antibiotics: trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin. Although the latter two drugs — developed decades ago — have shown efficacy against most urinary pathogens, no recent head-to-head comparisons have been reported. In this open-label trial, researchers randomized 513 women from Switzerland, Poland, and Israel with symptoms of UTI and consistent urine dipstick results to fosfomycin (a single 3-g dose) or nitrofurantoin (100 mg thrice daily for 5 days). Pregnant women and those with signs of sepsis or upper urinary tract disease were excluded.
Following completion of…