Clinical Efficacy and Cost Analysis of Antibiotics for Treatment of Uncomplicated Urinary Tract Infections in the Emergency Department of a Tertiary Hospital in Saudi Arabia.

Purpose: Uncomplicated urinary tract infections (uUTIs) are one of the main reasons for emergency department (ED) visits. Many antibiotics can be used for uUTI treatment. Currently, no data concerning uUTIs and cost-effectiveness have been reported in Saudi Arabia. This study aimed to investigate antibiotic and cost-effectiveness of beta-lactams, fluoroquinolones, and nitrofurantoin as first-line uUTI treatment.

Patients and methods: This study was a retrospective cohort based on a five-arm comparative outcome analysis. A cost-effectiveness analysis and comparative group of uUTI treatments in the ED at King Abdulaziz Medical City (KAMC) in Saudi Arabia over a three-month follow-up period was done. The patient group consisted of those presenting to the ED with uUTIs who were treated initially with one of five antibiotics: (1) amoxicillin/clavulanic acid, (2) cefuroxime, (3) ciprofloxacin, (4) nitrofurantoin, or (5) norfloxacin. The main outcomes were effectiveness in terms of cure rates, symptom-free days (SFDs), and estimations of cost-effectiveness among this group.

Results: A total of 865 adult patients who presented with uUTIs were enrolled. Most patients (89.5%) completely recovered, whereas 10.5% of patients were readmitted to the ED with recurrent infections. Effectiveness in terms of the highest cure rate was observed with nitrofurantoin and amoxicillin/clavulanic acid (93.2% and 92.2%, respectively) followed by norfloxacin, cefuroxime, and ciprofloxacin; no significant differences in cure rates were found among these antibiotics. Antibiotic effectiveness in terms of SFDs showed that nitrofurantoin produced the longest SFD period (76 days) followed by amoxicillin/clavulanic acid (69 days). A cost-effectiveness analysis in terms of uUTI cure rates and number of SFDs indicated that nitrofurantoin presented the highest cost-effectiveness followed by amoxicillin/clavulanic acid, norfloxacin, ciprofloxacin, and cefuroxime.

Conclusion: A comparison of five antibiotics for uUTI treatment did not yield clinically significant differences in cure rates. Nitrofurantoin was more cost-effective than the other antibiotics.