A Prospective Study on the Safety, Efficacy, and Cost-effectiveness of Nitrofurantoin for Urinary Tract Infections in Pregnancy

Objective: To prospectively evaluate the safety, efficacy, and cost-effectiveness of nitrofurantoin in the management of urinary tract infections (UTIs) among pregnant women over a 9 months period. Methods: This prospective cohort study enrolled 180 pregnant women diagnosed with either asymptomatic bacteriuria or symptomatic UTIs. Participants received nitrofurantoin therapy according to established clinical guidelines, with dosage and duration adjusted for gestational age. Data on clinical and bacteriological cure rates, recurrence rates, adverse maternal and fetal outcomes (including congenital malformations, preterm birth, and neonatal hemolytic anemia), and direct and indirect healthcare costs were collected over a 12-month follow-up period. Results: Preliminary findings indicate high clinical cure rates (88.9%) and bacteriological eradication rates (82.3%) with nitrofurantoin. Recurrence rates were low (2.1%). No significant increase in major congenital malformations was observed among first-trimester exposures. One case of neonatal hemolytic anemia was noted in a near-term exposure. Cost analysis revealed that while direct drug costs were moderate, the overall cost-effectiveness was favorable due to low treatment failure rates and reduced need for subsequent interventions. Conclusion: Nitrofurantoin demonstrates a favorable safety and efficacy profile for UTIs in pregnancy, aligning with current guidelines. Its cost-effectiveness is reinforced by its sustained effectiveness and low resistance rates, minimizing downstream healthcare expenditures. Continued vigilance regarding gestational age-specific contraindications remains paramount.