What is the recommended dose of Nitrofurantoin (antibiotic) for Escherichia coli (E. coli) Extended-Spectrum Beta-Lactamase (ESBL) urinary tract infection (UTI)?

From the Research

For E. coli ESBL UTI, nitrofurantoin is typically prescribed at 100 mg orally twice daily for 5-7 days for uncomplicated lower UTIs, as supported by the most recent study 1.

Key Considerations

• Nitrofurantoin remains effective against many ESBL-producing E. coli because its mechanism of action differs from beta-lactam antibiotics, which are inactivated by ESBL enzymes 2.
• The medication should be taken with food to improve absorption and reduce gastrointestinal side effects.
• Patients should complete the full course of treatment even if symptoms improve before completion.
• Nitrofurantoin is contraindicated in patients with creatinine clearance <30 mL/min, during pregnancy at term (38-42 weeks), during labor and delivery, and in infants under one month of age.

Special Populations

• For elderly patients or those with renal impairment, a lower dose of 50-100 mg four times daily may be used, as seen in study 2.
• In pediatric patients, nitrofurantoin has been shown to be effective in treating ESBL-producing E. coli UTIs, with a duration of treatment of 10 days 3.

Side Effects and Precautions

• Common side effects include nausea, headache, and urine discoloration.
• Patients should be advised to stay well-hydrated during treatment.
• Nitrofurantoin is appropriate only for lower UTIs as it does not achieve adequate tissue concentrations for treating pyelonephritis or systemic infections.

Resistance and Susceptibility

• More than 95% of all ESBL producing Enterobacteriacae were sensitive to nitrofurantoin, as reported in study 1.
• Nitrofurantoin may be an alternative option for uncomplicated UTIs with ESBL-EC, especially when other treatment options are limited 4.