To compare the effectiveness of five versus seven days of nitrofurantoin treatment for urinary tract infection (UTI) in diabetic women.
Data were collected retrospectively from Dutch general practitioners between 2013 and 2020. Nitrofurantoin prescriptions with a duration of five (5DN) or seven days (7DN) in women with diabetes were included. Inverse propensity weighting (IPW) was performed to calculate adjusted risk differences (RD) for treatment failure within 28 days. Secondary outcomes were 14-day treatment failure, severe treatment failure, and 28-day treatment failure in defined risk groups.
Nitrofurantoin was prescribed in 6866 episodes, 3247 (47,3%) episodes with 5DN and 3619 (52,7%) episodes with 7DN. Patients in the 7DN group had more co-morbidities, more diabetes-related complications and were more insulin-dependent. There were 517/3247 (15.9%) failures in the 5DN group versus 520/3619 (14.4%) in the 7DN group. The adjusted RD for failure within 28 days was 1.4% (95% CI -0.6 to 3.4).
We found no clinically significant difference in treatment failure in diabetic women with UTI treated either five or seven days with nitrofurantoin within 28 days. A 5-day treatment should be considered to reduce cumulative nitrofurantoin exposure in DM patients.

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