Postmenopausal UTIs: TMP-SMX Falls Short Compared with Nitrofurantoin or Fosfomycin
A large retrospective study using the TriNetX database found that trimethoprim-sulfamethoxazole (TMP-SMX) had higher rates of treatment failure within 7 days for postmenopausal women with acute uncomplicated UTIs compared with nitrofurantoin and fosfomycin. TMP-SMX was about 28% more likely to fail than nitrofurantoin and about 39% more likely than fosfomycin; nitrofurantoin and fosfomycin had similar overall failure rates, though nitrofurantoin reduced hospitalization risk. Postmenopausal status may alter UTI risk and antibiotic effectiveness due to estrogen deficiency and microbiome changes; study limitations include retrospective design and reliance on diagnostic codes.