TOPLINE:

Gepotidacin and nitrofurantoin were comparable in providing early symptom relief in patients with uncomplicated urinary tract infection (UTI), with more than 70% of patients showing clinical improvement within 2-4 days of starting treatment.

METHODOLOGY:

• Researchers conducted a pooled analysis of data of 3136 women with uncomplicated UTI from EAGLE-2 and EAGLE-3 trials to assess early clinical responses and the effect of day-to-day changes in symptom severity.
• Patients were randomly assigned to receive 1500 mg oral gepotidacin (n = 1572; mean age, 48.9 years) or 100 mg nitrofurantoin (n = 1564; mean age, 49.4 years) twice daily for 5 days; included patients had at least two symptoms of dysuria, frequency, urgency, or lower abdominal pain and evidence of urinary nitrite and/or pyuria.
• Symptom severity for dysuria, frequency, urgency, and lower abdominal pain was assessed at each visit and assigned a score of 0-3, reflecting effect on daily activities, where 0 indicated no effect and 3 indicated severe effect.
• Clinical outcomes were clinical resolution (a total symptom score of 0), clinical improvement (a reduction in the score from baseline), clinical worsening (an increase or no change in the score), or classified as unable to determine and were assessed at baseline (day 1), on-therapy visits (days 2-4), and test-of-cure visits (days 10-13).

TAKEAWAY:

• At the on-therapy visit, 10.2% of patients in the gepotidacin group vs 9.5% of those in the nitrofurantoin group achieved clinical resolution, and clinical improvement was observed in 71.2% and 72.6% of patients, respectively.
• A similar decline in mean total symptom scores was observed in the gepotidacin and nitrofurantoin groups from baseline (7.1 and 7.2, respectively) to on-therapy (3.6 each) and test-of-cure (0.6 and 0.8, respectively) visits.
• At the test-of-cure visit, 66.5% of patients in the gepotidacin group compared with 64.0% of those in the nitrofurantoin group achieved clinical resolution, with clinical improvement observed in 22.1% and 25.9% of patients, respectively.
• No significant group difference was observed for clinical worsening and unable to determine outcomes.

IN PRACTICE:

“In patients that need an alternative option to standard-of-care treatment, gepotidacin may be an option that enables them to resume normal daily activities shortly after initiating treatment,” the authors wrote.

SOURCE:

This study was led by Amanda J. Sheets, PhD, GSK, Collegeville, Pennsylvania. It was published online on January 6, 2026, in Clinical Infectious Diseases.

LIMITATIONS:

Early clinical response at on-therapy visits was assessed over several days rather than at fixed timepoints, and the timing of relief from individual symptoms was not assessed. Additionally, any reduction in symptom scores was considered improvement, which may not have reflected a meaningful benefit to quality of life.

DISCLOSURES:

The EAGLE-2 study was supported by GSK, the US Department of Health and Human Services, the Administration for Strategic Preparedness and Response, and the Biomedical Advanced Research and Development Authority, and the EAGLE-3 study was funded by GSK. Six authors reported being employees of and holding financial equities in GSK, and two reported receiving honoraria from GSK.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.