From the Guidelines
Yes, nitrofurantoin can be used for uncomplicated urinary tract infections (UTIs) caused by ESBL-producing E. coli, as recommended by the most recent guidelines 1. The typical dosage is nitrofurantoin monohydrate/macrocrystals (Macrobid) 100 mg twice daily for 5 days, as suggested by the American College of Physicians 1. Nitrofurantoin remains effective against many ESBL-producing organisms because its mechanism of action differs from beta-lactam antibiotics, and resistance rates remain relatively low 1. It achieves high concentrations in the urine, making it effective for lower UTIs, but should not be used for pyelonephritis or systemic infections. Some key points to consider when prescribing nitrofurantoin include:
- Avoiding its use in patients with creatinine clearance below 30 ml/min
- Avoiding its use during pregnancy at term (38-42 weeks), during labor and delivery, and in infants under one month
- Common side effects include nausea, headache, and urine discoloration
- Taking it with food can help reduce gastrointestinal side effects
- Patients should complete the full course of treatment even if symptoms improve before finishing the medication. The American College of Physicians recommends short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days, or fosfomycin as a single dose for women with uncomplicated bacterial cystitis 1. However, nitrofurantoin is the preferred choice due to its efficacy and low resistance rates 1.
From the Research
Nitrofurantoin for ESBL E. coli Uncomplicated UTI
- Nitrofurantoin can be used to treat uncomplicated urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli 2, 3, 4, 5, 6.
- Studies have shown that nitrofurantoin has good susceptibility against ESBL-producing E. coli, with susceptibility rates ranging from 83.2% to 96.3% 3, 4, 6.
- Nitrofurantoin may be an alternative option for uncomplicated UTIs with ESBL-producing E. coli, especially when other treatment options are limited 2, 5.
- The effectiveness of nitrofurantoin against ESBL-producing E. coli has been demonstrated in various studies, with clinical and microbiological success rates ranging from 68% to 83.2% 5, 6.
Comparison with Other Antibiotics
- Nitrofurantoin has been compared to other antibiotics, such as fosfomycin and pivmecillinam, and has shown similar or higher effectiveness against ESBL-producing E. coli 3, 4, 6.
- Fosfomycin has also been shown to be effective against ESBL-producing E. coli, but its susceptibility rate may be lower than that of nitrofurantoin in some cases 2, 4.
- Pivmecillinam has been shown to be effective against ESBL-producing E. coli, but its use may be limited by its lower susceptibility rate against other Enterobacteriaceae species 3, 6.
Clinical Implications
- The use of nitrofurantoin for uncomplicated UTIs caused by ESBL-producing E. coli may help to reduce the risk of antibiotic resistance and improve treatment outcomes 2, 5, 6.
- Clinicians should consider the use of nitrofurantoin as an alternative treatment option for uncomplicated UTIs caused by ESBL-producing E. coli, especially when other treatment options are limited 2, 5.