Study Comparing Nitrofurantoin to Fosfomycin for Acute Urinary Tract Infection in Women

Inclusion Criteria: * Female gender * Age ≥ 18 years * Written informed consent * At least one of four key UTI symptoms that could be attributed to an uncomplicated UTI, and no alternative explanation (i.e. symptoms suggestive of STI or vulvo-vaginitis): * Dysuria * Urgency (including nocturia) * Frequency * Suprapubic tenderness * Urine dipstick test positive for either nitrites or leukocyte esterase * Patient is at increased risk for resistant pathogens, e.g., FQ-resistant or ESBL-producing Enterobacteriacae Exclusion Criteria: * Male sex * Pregnancy or planned pregnancy * Known carriage of nitrofurantoin- or fosfomycin-resistant uropathogens(s) * Concomitant antimicrobial therapy * Use of any antibiotics in the past 7 days * Known or suspected hypersensitivity or allergy to fosfomycin or nitrofurantoin * History of lung or liver reaction or peripheral neuropathy after use of nitrofurantoin or other nitrofurans in the past * Pre-existing polyneuropathy * G6PD deficiency * Symptoms consistent with UTI in the preceding 4 weeks * Active upper UTI (e.g. pyelonephritis, urosepsis: fever \> 38.0, flank pain, chills) * Symptoms/signs suggestive of vaginitis or sexually transmitted infection * Indwelling catheter, nephrostomy, ureter stent or other foreign material * Otherwise complicated UTI: * A history of anatomical or functional abnormalities of the urogenital tract: * Congenital abnormalities * Polycystic kidney disease * Obstruction or stricture of renal pelvis, ureter or …