Daily Nitrofurantoin Versus Bladder Fulguration Plus Daily Nitrofurantoin for Women With Recurrent Urinary Tract Infections

A Multicentric Randomized Trial of Daily Nitrofurantoin Versus Bladder Fulguration Plus Daily Nitrofurantoin for the Long-term Management of Cystitis in Women With Recurrent Urinary Tract Infections

The goal of this clinical trial is to learn if the drug Nitrofurantoin (NF) taken as a daily antibiotic, works to treat cystitis compared to electrofulguration (EF) and Nitrofurantoin (NF) daily antibiotic.

Study Overview

• Status: Recruiting
• Conditions: Recurrent UTIs; Cystitis Recurrent
• Intervention / Treatment: Drug: Nitrofurantoin (NF); Procedure: Electrofulguration (EF)

Detailed Description

This is a study for women age 18 -85 with a well-documented history of rUTI (recurrent urinary tract infection) for at least one year. This randomized multicentric clinical trial will determine the efficacy of conventional 6 months Nitrofurantoin (NF) daily antibiotic prophylaxis alone versus electrofulguration (EF) associated with a 6 months NF daily antibiotic prophylactic course for early stages of chronic cystitis (stages 1 and 2) as determined on office cystoscopy.

This study will ask the participant (n=104) to return to the Urology clinic at UT Southwestern Medical Center (n=52) or The University of Kansas Medical Center (n=52) for a total of 8 compensated visits throughout 30 months after the start of this randomized trial to make sure that the treatment worked well for them.

• Study Type: Interventional
• Enrollment (Estimated): 104
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Meghan Leak; Phone Number: 214-645-8787; Email: utswuti@utsouthwestern.edu
• Study Contact Backup: Name: Philippe Zimmern, M.D.

Study Locations

• United States
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • Not yet recruiting
      • The University of Kansas
      • Contact: Colby Souders, MD; Phone Number: 913-588-6146; Email: csouders@kumc.edu
      • Principal Investigator: Colby Souders, MD
  • Texas
    • Dallas, Texas, United States, 75390
      • Recruiting
      • UT Southwestern Medical Center
      • Contact: Meghan B Leak; Phone Number: 214-645-8787; Email: meghan.leak@utsouthwestern.edu
      • Contact: Jessica de Araujo Paula; Phone Number: 214-645-8787; Email: jessica.dearaujopaula@utsouthwestern.edu
      • Principal Investigator: Philippe Zimmern, MS
      • Sub-Investigator: Colby Souders, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Females 18 to 85 years old with at least a 1-year history of culture documented uncomplicated rUTI.
• Diagnosis of rUTI, defined as ≥ 3 symptomatic UTIs in 12 months or ≥ 2 in 6 months.
• Currently free from a UTI determined based on absence of symptoms as determined by the UTI symptom assessment questionnaire and negative urine culture (<10^3 colony forming units per ml of urine).
• A negative upper and lower urinary tract evaluation, including pelvic examination for pelvic organ prolapse (less than or equal to stage 2), measurement of post-void residual (less than 50 ml), and imaging (which may include renal ultrasound and standing voiding cystourethrogram) to exclude kidney stone, hydronephrosis, reflux, or urethral diverticulum.
• Office cystoscopy documenting stages 1 or 2 of chronic cystitis.
• Likely to stay in the geographic region for the duration of the study.
• ASA class II or less.

Exclusion Criteria:

• Patients on antibiotics at baseline (i.e., suppressive therapy or antibiotic therapy for non-urinary infections).
• Patients on self-start therapy (i.e., taking antibiotics upon start of urinary symptoms concerning for UTI).
• Patients on prophylactic antibiotics started in the last 3 months and unwilling to discontinue, or intention to start in the next 12 months.
• Complicated UTIs, including neurogenic bladder condition (i.e., multiple sclerosis, Parkinson's disease, spinal cord injury), bladder augmentation, or urinary diversion.
• Patients with urinary catheters (including indwelling Foley, intermittent catheterization, and suprapubic catheters).
• Uncontrolled diabetes (HbA1c >9).
• Pregnancy
• Allergy or resistance to Nitrofurantoin.
• Chronic lung or liver condition precluding the use of Nitrofurantoin, including abnormal chest X ray or elevated liver function tests.
• Chronic renal insufficiency (creatinine over 1.5 g/dl or GFR less than 40) precluding the use of Nitrofurantoin.
• History of chronic diarrhea requiring regular therapy.
• Patients with psychosis, dementia, swallowing disorders, or any other ability to take Nitrofurantoin reliably at home.
• BMI over 40.
• Use of Uromune or other vaccine approaches to reduce rUTI episodes
• Participation in a research study involving an investigational product in the past 12 weeks.
• Patients receiving phage therapy.
• Current diagnosis of interstitial cystitis.
• Patients with medical conditions requiring excessively large amounts of fluid intake.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Nitrofurantoin (NF) daily antibiotic prophylaxis; Nitrofurantoin (NF) daily antibiotic prophylaxis given daily for 6 months.	Drug: Nitrofurantoin (NF); Nitrofurantoin (NF) daily antibiotic prophylaxis given daily for 6 months.
Experimental: Nitrofurantoin (NF) daily antibiotic prophylaxis plus electrofulguration (EF)	Drug: Nitrofurantoin (NF); Nitrofurantoin (NF) daily antibiotic prophylaxis given daily for 6 months.; Procedure: Electrofulguration (EF); Nitrofurantoin (NF) daily antibiotic prophylaxis for 6 months plus Electrofulguration.; Other Names: fulguration

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Treatment of cystitis with NF vs EF+NF	Rate of culture documented symptomatic UTIs following the completion of each 6-month study arm intervention. Specifically, from 6 to 18 months (first year) after the completion of the original intervention and, 18 to 30 months (second year).	Baseline to 30 months after enrollment to completion of study

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
No recurring cystitis	Comparison of patient characteristics between the two enrolling institutions.	Baseline to 30 months after enrollment to completion of study
Rate comparison of culture-documented breakthrough	Rate of culture-documented breakthrough UTIs between the two treatment arms.	Baseline to 30 months after enrollment to completion of study
Rate of multi-drug resistant organisms	Rate of urine cultures showing multi-drug resistant organisms in each treatment arm.	Baseline to 30 months after enrollment to completion of study
Rate of non-urine culture	Rate of non-urine culture documented symptomatic UTI episodes for 12 months and 24 months following end of treatment arms, as determined by the Urinary Tract Infection Symptom Assessment (UTISA) (a total score of 3 or higher, or any individual score of 2 or 3) between the two treatment arms.	Baseline to 30 months after enrollment to completion of study
Rate of behavior changes	Rate of behavior changes in both groups (fluid increases or use of non-antibiotic therapies, e.g., cranberry, D-mannose, urinary analgesics, hormonal therapy) in each treatment arm.	Baseline to 30 months after enrollment to completion of study
Rate of score differences in symptoms and quality of life	Rate of score differences in patient symptoms and quality of life assessments using validated questionnaires- the Urinary Tract Infection Symptom Assessment (UTISA), Urinary Distress Inventory, Short Form (UDI-6), and Quality of Life scale (QoL) by Visual Analogue Scale (VAS) between both treatment arms.	Baseline to 30 months after enrollment to completion of study
Rate of UTI episodes	Rate of UTI episodes (after first and second year of the completion of the intervention) compared to the rate of UTI episodes prior to the start of study	Baseline to 30 months after enrollment to completion of study

Collaborators and Investigators

• Sponsor: University of Texas Southwestern Medical Center
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Institutes of Health (NIH); University of Texas
• Investigators: Principal Investigator: Philippe Zimmern, M.D., University of Texas Southwestern Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): April 6, 2026
• Primary Completion (Estimated): July 1, 2028
• Study Completion (Estimated): January 30, 2029

Study Registration Dates

• First Submitted: March 24, 2025
• First Submitted That Met QC Criteria: March 31, 2025
• First Posted (Actual): April 2, 2025

Study Record Updates

• Last Update Posted (Actual): May 1, 2026
• Last Update Submitted That Met QC Criteria: April 27, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Nitrofurantoin; Recurrent UTI; bladder fulguration; long-term managenent of cystitis; chronic UTI
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Infections; Urinary Tract Infections; Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Therapeutics; Hyperthermia, Induced; Nitro Compounds; Furans; Nitrofurans; Nitrofurantoin; Diathermy
• Other Study ID Numbers: STU-2024-1187; 1R01DK140224-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: Yes