What factors should guide the choice between fosfomycin and nitrofurantoin for uncomplicated cystitis, given the reduced efficacy of fosfomycin?

I agree with the authors you reference that, though fosfomycin is listed as a first-line option in the 2011 IDSA UTI guidelines for uncomplicated cystitis, our assessment of its efficacy has changed somewhat since then.

We now have two larger randomized controlled trials that demonstrate that women r...

I completely agree. I keep fosfomycin as a last case resort and save it mostly for MDR e coli.