Can I use Macrobid (nitrofurantoin) on a patient allergic to cefepime, daptomycin, doxycycline, penicillin, and sulfa?

From the Guidelines

You can generally use Macrobid (nitrofurantoin) in a patient allergic to cefepime, daptomycin, doxycycline, penicillin, and sulfa medications, as nitrofurantoin belongs to a different chemical class and cross-reactivity is unlikely. The patient's allergies to cefepime, daptomycin, doxycycline, penicillin, and sulfa medications do not directly impact the use of Macrobid, as it is a distinct antibiotic class 1.

When considering the use of Macrobid, it is essential to evaluate the patient's renal function, as the drug is contraindicated in patients with poor kidney function (creatinine clearance <30 mL/min) 1. Additionally, other contraindications such as G6PD deficiency, pregnancy at term (38-42 weeks), and pulmonary disease history should be assessed.

The standard dosage for uncomplicated urinary tract infections is typically Macrobid 100 mg twice daily for 5-7 days. Nitrofurantoin works by damaging bacterial DNA and is particularly effective against common urinary pathogens like E. coli. It concentrates in the urinary tract, making it specifically useful for UTIs but not appropriate for systemic infections. Monitor for side effects including nausea, which can be minimized by taking with food.

It is crucial to note that the provided guidelines and studies primarily focus on beta-lactam antibiotics and do not directly address the use of Macrobid in patients with the specified allergies 1. However, given the distinct chemical class of nitrofurantoin, it can be considered a viable option for treating urinary tract infections in patients with these allergies, while prioritizing the patient's safety and monitoring for potential side effects.

From the FDA Drug Label

ADVERSE REACTIONS: ... Allergic: A lupus-like syndrome associated with pulmonary reactions to nitrofurantoin has been reported Also, angioedema; maculopapular, erythematous, or eczematous eruptions; pruritus; urticaria; anaphylaxis; arthralgia; myalgia; drug fever; chills; and vasculitis (sometimes associated with pulmonary reactions) have been reported. Hypersensitivity reactions represent the most frequent spontaneously-reported adverse events in worldwide postmarketing experience with nitrofurantoin formulations

The patient's allergies to cefepime, daptomycin, doxycycline, penicillin, and sulfa are not directly related to nitrofurantoin. However, given the patient's history of multiple allergies, it is crucial to exercise caution.

• The drug label does mention hypersensitivity reactions, but it does not provide specific information about cross-reactivity with the mentioned allergens.
• There is no direct information in the label that supports the safe use of nitrofurantoin in a patient with these specific allergies.
• Considering the potential for hypersensitivity reactions and the lack of direct information, it is recommended to avoid using Macrobid (nitrofurantoin) in this patient or to use it with extreme caution and close monitoring 2.

From the Research

Allergies and Macrobid Use

• The patient is allergic to cefepime, daptomycin, doxycycline, penicillin, and sulfa.
• Macrobid (nitrofurantoin) is a commonly used antibiotic for urinary tract infections.

Cross-Reactivity with Macrobid

• There is no direct evidence of cross-reactivity between Macrobid and the listed allergies, except for sulfa.
• According to 3, the weight of evidence suggests that withholding nonantibacterial sulfonamides from patients with prior reactions to antibacterial sulfonamides or other nonantibacterial sulfonamides is not clinically justified.
• However, Macrobid is not a sulfonamide, it is a nitrofuran, and its structure is different from sulfonamides.

Safety of Macrobid Use

• Studies 4 and 5 suggest that Macrobid is a safe and effective treatment for urinary tract infections, with a low resistance rate.
• There is no evidence to suggest that Macrobid is contraindicated in patients with allergies to cefepime, daptomycin, doxycycline, penicillin, and sulfa.

Multiple Drug Allergies

• The patient has multiple drug allergies, which may indicate multiple drug intolerance syndrome, as discussed in 6.
• However, this does not necessarily mean that the patient will be allergic to Macrobid, as it is a distinct class of antibiotic.