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 uncomplicated community-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