From the Guidelines
Nitrofurantoin is a recommended first-line antibiotic for uncomplicated urinary tract infections (UTIs), with a typical dosage of 100 mg taken orally twice daily for 5 days, as supported by the most recent guidelines from the American College of Physicians 1.
Key Considerations
- The dosage and duration of nitrofurantoin treatment may vary depending on the specific formulation and patient factors, such as kidney function and pregnancy status.
- Nitrofurantoin is effective against common UTI pathogens like E. coli and achieves high concentrations in urine, making it suitable for lower urinary tract infections.
- Patients should complete the full course of treatment even if symptoms improve quickly and be aware of potential side effects, such as nausea, headache, and dark urine.
Important Safety Information
- Nitrofurantoin should be avoided in patients with kidney impairment (creatinine clearance <60 mL/min), during late pregnancy, in those with G6PD deficiency, or with a history of lung reactions to the medication.
- Rare but serious side effects include lung reactions and liver damage with long-term use.
Evidence-Based Recommendations
- The American College of Physicians recommends nitrofurantoin as a first-line treatment option for uncomplicated UTIs, along with trimethoprim-sulfamethoxazole and fosfomycin 1.
- The Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases also recommend nitrofurantoin as a treatment option for acute uncomplicated cystitis and pyelonephritis in women 1.
From the Research
Nitrofurantoin for UTI
- Nitrofurantoin is recommended as a first-line agent for the treatment of uncomplicated cystitis 2, 3, 4, 5
- The choice of nitrofurantoin as a treatment option is based on its efficacy, safety, and low resistance rates among uropathogens 4, 5
- A 5-day course of nitrofurantoin has been shown to be effective in achieving clinical and microbiologic resolution of uncomplicated lower urinary tract infection in women 6
- Nitrofurantoin is considered a suitable alternative to other antibiotics, such as trimethoprim-sulfamethoxazole and fluoroquinolones, which have higher resistance rates 2, 3, 4
- The use of nitrofurantoin as a first-line treatment for uncomplicated UTI is supported by several guidelines, including the S3 guideline on uncomplicated urinary tract infections 4, 5
Comparison with Other Antibiotics
- Nitrofurantoin has been compared to fosfomycin in a randomized clinical trial, which showed that nitrofurantoin was more effective in achieving clinical and microbiologic resolution of uncomplicated lower urinary tract infection in women 6
- Nitrofurantoin is considered to have a lower risk of "collateral damage" compared to other antibiotics, such as fluoroquinolones and group 3 cephalosporins 4
- The choice of nitrofurantoin as a treatment option should be based on individual patient factors, such as prior antibiotic use and resistance patterns 4