From the Guidelines
Nitrofurantoin is not recommended for a 74-year-old female with impaired renal function and a UTI. This medication is contraindicated in patients with significant renal impairment (creatinine clearance less than 30 ml/min) because it becomes ineffective when kidney function is poor and can lead to toxic levels in the bloodstream, increasing the risk of adverse effects including pulmonary toxicity and peripheral neuropathy 1. Additionally, nitrofurantoin is generally not recommended for elderly patients over 65 with any degree of renal impairment due to the natural decline in kidney function with age.
Alternative Treatment Options
- Trimethoprim-sulfamethoxazole: a suitable alternative, with a recommended dose of 160/800 mg twice daily for 3 days, as per the guidelines from the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1.
- Ciprofloxacin: a fluoroquinolone that can be used as an alternative, but its use should be reserved for patients with a history of resistant organisms due to its high propensity for adverse effects 1.
- Amoxicillin-clavulanate: another alternative, but its use should be guided by local resistance patterns and the patient's specific circumstances, including allergy history and previous antibiotic exposures. The selection of an alternative antibiotic should be guided by local resistance patterns and the patient's specific circumstances, including allergy history and previous antibiotic exposures 1. It is essential to consider the patient's renal function when choosing an alternative antibiotic and adjust the dosing accordingly to minimize the risk of adverse effects.
From the Research
Nitrofurantoin Dosing for UTI in a 74-Year-Old Female
The recommended dose of nitrofurantoin for a 74-year-old female with a urinary tract infection (UTI) and impaired renal function is not explicitly stated in the provided studies. However, the following points can be considered:
- A study published in 2015 2 found that the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin.
- The American Geriatrics Society updated the Beers criteria in 2015 to recommend nitrofurantoin for short-term use in patients with a creatinine clearance (Clcr) greater than or equal to 30 mL/min 3.
- A 2023 study 4 found that nitrofurantoin exposure was not affected by age and eGFR, and the data obtained do not support the discouragement of nitrofurantoin use in the elderly and in patients with impaired renal function.
- The 2016 updated recommendations 5 suggest that nitrofurantoin can be used in patients with a Clcr of 30 mL/min or greater.
Key Considerations
- The dosage regimen of nitrofurantoin may not affect drug exposure in female patients with different age and renal function 4.
- Nitrofurantoin can be considered as the most effective drug in the treatment of acute urinary infection, but its long-term side effects, especially in elderly patients, should be taken into account 6.
- The safety and efficacy of nitrofurantoin for UTIs in medically complex patients with renal impairment living in a community setting have been evaluated, and it highlights the potential role for pharmacists to encourage antimicrobial stewardship 3.