NEW pooled analyses from two large randomised trials suggest that gepotidacin, a novel oral antibiotic, provides early and meaningful symptom relief comparable to nitrofurantoin in patients with uncomplicated urinary tract infection (UTI). The findings bring renewed attention to patient-reported symptom outcomes, an aspect often under-represented in uncomplicated UTI trials despite its importance to daily functioning.
Uncomplicated urinary tract infection is one of the most common bacterial infections treated in primary and urgent care, frequently causing pain, urinary urgency, and disruption to everyday activities. While microbiological cure is a standard trial endpoint, rapid symptom improvement is often what matters most to patients.
Symptom Relief in Uncomplicated UTI
The analysis pooled data from the phase 3 EAGLE-2 and EAGLE-3 trials, which together included more than 3,100 participants aged 12 years and older. All participants had at least two uncomplicated UTI symptoms and objective evidence of infection, and were randomised to receive either oral gepotidacin or nitrofurantoin for five days.
Symptom severity was assessed using a standardised score covering urinary frequency, urgency, dysuria, and suprapubic pain. At baseline, symptom burden was moderate to severe in both groups, with mean scores just over 7 out of 12. By days 2–4 of treatment, mean symptom scores had halved to 3.6 in both treatment arms. More than 80% of participants experienced clinical improvement or complete symptom resolution during therapy.
Impact on Daily Activities
Among participants whose symptoms initially interfered with everyday activities, just over half in each group reported that symptoms no longer affected daily life within the first few days of treatment. By the test-of-cure visit at 10–13 days, more than 93% of participants in both groups reported minimal or no impact on daily activities. The near-identical trajectories observed with gepotidacin and nitrofurantoin reinforce the similarity of their symptom-relief profiles.
Looking Ahead
The findings suggest that gepotidacin offers symptom relief on par with a well-established first-line agent. While the trials were not designed to demonstrate superiority, the emphasis on early patient-reported outcomes is clinically relevant, particularly in shared decision-making. As antimicrobial resistance continues to limit treatment options, having alternative agents that deliver comparable symptom control may be valuable.
Reference
Sheets AJ et al. Early symptom response in patients with uncomplicated urinary tract infection treated with gepotidacin or nitrofurantoin: pooled analysis from two pivotal Phase 3 studies. Clin Infect Dis. 2026; DOI:10.1093/cid/ciaf722.
