From the Guidelines
Nitrofurantoin (Macrobid) can be used to treat urinary tract infections in children, but it is not recommended for those with significant renal impairment or under 4 months of age due to the risk of hemolytic anemia. When considering the use of Macrobid in children, it's essential to weigh the benefits and risks, particularly in those with impaired renal function. According to the European Association of Urology/European Society of Paediatric Urology guidelines 1, nitrofurantoin is one of the antibiotics commonly used for continuous antibiotic prophylaxis (CAP) in children with vesicoureteral reflux (VUR). However, the guidelines also recommend avoiding nitrofurantoin before the age of 4 months due to the risk of hemolytic anemia 1. Key considerations for using Macrobid in children include:
- The child's age: Nitrofurantoin is not recommended for children under 4 months of age due to the risk of hemolytic anemia 1.
- Renal function: Nitrofurantoin is contraindicated in patients with significant renal impairment (creatinine clearance less than 30 ml/min) because the drug requires adequate kidney function to concentrate in the urine and achieve therapeutic levels.
- Alternative antibiotics: For children with renal impairment, alternative antibiotics such as trimethoprim-sulfamethoxazole or cephalosporins would be more appropriate choices based on culture and sensitivity results. In summary, while Macrobid can be used to treat urinary tract infections in children, its use should be approached with caution, particularly in those with impaired renal function or under 4 months of age, and alternative antibiotics should be considered based on individual patient needs and renal function.
From the Research
Use of Macrobid in Children
- Macrobid (nitrofurantoin) can be used to treat urinary tract infections (UTIs) in children, but its use is subject to certain considerations 2.
- Children with impaired renal function may require careful monitoring while taking Macrobid, as the drug is contraindicated in patients with significant renal impairment.
- A study published in 2019 found that oral nitrofurantoin treatment was effective in children with lower UTIs caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, with a bacteriological response rate of 98% 2.
- However, another study published in 1998 found that nitrofurantoin prophylaxis did not effectively eradicate bacteriuria in children with neurogenic bladder on intermittent catheterization, and may even lead to the emergence of resistant organisms 3.
Special Considerations
- Patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may be at risk of hemolytic reactions when taking Macrobid, although the risk is considered to be low 4, 5.
- A study published in 2022 suggested that a total daily dose of 200 mg Macrobid may be used for short-term UTI treatment without G6PD screening, but recommended pharmacovigilance in countries with high prevalence of G6PD deficiency 4.
- It is essential to carefully evaluate the benefits and risks of using Macrobid in children, particularly those with underlying medical conditions or impaired renal function.
Dosage and Administration
- The dosage and administration of Macrobid in children should be guided by the specific clinical circumstances and the child's renal function.
- The study published in 2019 used a dosage of 10 days of oral nitrofurantoin treatment in children with lower UTIs caused by ESBL-producing E. coli 2.
- However, the optimal dosage and duration of treatment may vary depending on the specific clinical scenario, and should be determined in consultation with a qualified healthcare professional.