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Nitrofurantoin (Macrobid, Macrodantin)

Nitrofurantoin

Nitrofurantoin

Nitrofurantoin suspension

KEY POINTS

  • Nitrofurantoin is an antibiotic used to treat or prevent urinary tract infections
  • Is reduced by bacterial flavoproteins to reactive intermediates that inactivate or alter bacterial ribosomal proteins. This leads to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA and cell wall synthesis.
    • Bactericidal in urine at therapeutic doses
    • E. coli (the most common bacteria to cause UTI) resistance is typically not as bad as that of with E. coli and ciprofloxacin or sulfamethoxazole-trimethoprim (Bactrim, SMX/TMP). This means nitrofurantoin may be a good choice for empiric therapy (i.e., when sensitivity is not known), but lower UTI is diagnosed and E. coli is suspected.
  • Is indicated for lower urinary tract infections (i.e., not for pyelonephritis) and is also not a good choice if concern for prostatitis is present
  • Dosing depends on the product
    • Furadantin and Macrodantin are dosed 50-100mg every 6 hours
    • Macrobid is dosed 100mg twice daily
      • Note: “BID” is in the name and it is twice daily
  • Generally avoid use in CrCl < 30 mL/min or elderly (>65 years old)
    • Note: 60 mL/min was the previous cut-off, see link below: updated Beers Criteria 2015
    • Poor kidney function will mean lower urinary concentrations and higher risk for toxicity
  • Is normally well tolerated, but repeated or long-term use has been associated with pulmonary toxicity
    • Liver toxicity, optic neuritis, and peripheral neuropathy have been reported

RESOURCES

    • Nitrofurantoin Macrocrystals (Macrodantin) Package Insert
    • Nitrofurantoin Monohydrate/Macrocrystals (Macrobid) Package Insert
    • Nitrofurantoin Oral Suspension (Furadantin) Package Insert
    • IDSA UTI Guidelines
    • American Geriatrics Society 2015 Updated Beers Criteria For Potentially Inappropriate Medication Use in Older Adults
    • Nitrofurantoin Systematic Review & Meta-Analysis (2015, JAC) [free]
    • Nitrofurantoin Systematic Review & Meta-Analysis Focusing On Safety/Efficacy For UTI Prophylaxis (2016, CMI)


 

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