From the Guidelines
Macrobid (nitrofurantoin) can be used to treat a urinary tract infection caused by Escherichia coli as shown in this urine culture, with a recommended dosage of 100 mg taken orally twice daily for 5 days, as suggested by the European Association of Urology guidelines 1. The European Association of Urology guidelines provide a suggested antimicrobial therapy regimen for uncomplicated cystitis, which includes nitrofurantoin macrocrystals as a first-line treatment option 1.
- The guidelines recommend a daily dose of 50-100 mg q.i.d. or 100 mg b.i.d. for 5 days, with the option of a prolonged release formulation also available 1.
- Nitrofurantoin is generally effective against E. coli, with good in vitro activity reported in various studies, including a 2011 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1.
- It is essential to consider local antimicrobial susceptibility patterns, as resistance rates can vary significantly between regions and countries 1.
- However, according to the most recent guidelines, nitrofurantoin remains a suitable option for empirical therapy in most regions, with a low resistance rate compared to other antimicrobials 1.
- Patients should be advised to take the full course of antibiotics, drink plenty of fluids, and take the medication with food to reduce stomach upset and improve absorption.
- Additionally, it is crucial to note that Macrobid may not be suitable for patients with severe kidney impairment or G6PD deficiency, and its use should be carefully considered in these cases.
From the Research
Treatment Options for Urine Culture with Escherichia coli
- The use of macrobin (nitrofurantoin) is supported by several studies as an effective treatment for urinary tract infections (UTIs) caused by Escherichia coli 2, 3, 4.
- Nitrofurantoin has been shown to have a high susceptibility rate against E. coli, with an average resistance rate of 2.3% 2.
- In comparison, other antibiotics such as ciprofloxacin and levofloxacin have higher resistance rates, ranging from 24% to 29% 2, 5.
- The use of nitrofurantoin as a first-line treatment for uncomplicated UTIs is recommended due to its low resistance rate and effectiveness against E. coli 2, 4.
Considerations for Antibiotic Resistance
- The increasing resistance of E. coli to trimethoprim-sulfamethoxazole (TMP-SMX) has led to a reassessment of empiric therapy for UTIs 3, 5.
- Risk factors for TMP-SMX resistance in E. coli include recurrent UTIs, genitourinary abnormalities, and previous use of TMP-SMX within 90 days 5.
- The use of an ED-specific antibiogram is recommended to assess local resistance rates and guide empiric antibiotic prescribing for UTIs 5.
Alternative Treatment Options
- Amoxicillin/clavulanate and sulfamethoxazole/trimethoprim are alternative treatment options for UTIs, although their effectiveness may vary depending on the specific population and resistance rates 6.
- Ciprofloxacin is not recommended as a first-line treatment due to its low susceptibility rates against commonly encountered pathogens 6.