From the Guidelines
The typical dosing of MacroBID (nitrofurantoin) for uncomplicated urinary tract infections is 100 mg taken orally twice daily for 5 days. This recommendation is based on the most recent and highest quality study, which suggests that a 5-day course of nitrofurantoin is sufficient for women with acute uncomplicated cystitis 1. For men, the treatment duration may be extended to 7 days. It is essential to take MacroBID with food to enhance absorption and reduce gastrointestinal side effects such as nausea. Patients should complete the entire prescribed course even if symptoms improve before finishing the medication. Nitrofurantoin works by damaging bacterial DNA and is concentrated in the urine, making it effective specifically for lower urinary tract infections. It is not appropriate for upper UTIs or pyelonephritis. Adequate hydration should be maintained during treatment, but patients should avoid taking antacids containing magnesium trisilicate as they can reduce nitrofurantoin's effectiveness. The medication may cause harmless urine discoloration (brown or yellow), and patients should be aware that dizziness can occur, potentially affecting driving or operating machinery.
Some key points to consider when prescribing MacroBID include:
- The medication should be taken with food to minimize gastrointestinal side effects
- Patients should complete the entire prescribed course, even if symptoms improve before finishing the medication
- Nitrofurantoin is not appropriate for upper UTIs or pyelonephritis
- Adequate hydration should be maintained during treatment
- Patients should avoid taking antacids containing magnesium trisilicate during treatment
It is also important to note that the IDSA/European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline recommends treatment durations depending on the type of antibiotic, including 5 days of nitrofurantoin, 3 days of TMP–SMX, or a single dose of fosfomycin 1. However, the most recent and highest quality study supports the use of a 5-day course of nitrofurantoin for uncomplicated urinary tract infections.
From the Research
MacroBID Dosing for UTI
- The typical dosing of MacroBID (nitrofurantoin) for uncomplicated urinary tract infections (UTIs) is 100 mg twice daily for 7 days 2, 3.
- Nitrofurantoin is considered a second-line therapy for UTIs, but its use has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI) 4.
- The choice of antibiotic for UTI treatment depends on various factors, including the patient's individual risk profile, prior antibiotic treatment, and the spectrum of pathogens and antibiotic susceptibility 3.
Treatment Duration and Guidelines
- The duration of treatment with MacroBID is typically 7 days, but some studies have found that treatment durations longer than recommended are common 5.
- Guidelines recommend that asymptomatic bacteriuria should only be treated in exceptional situations, such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract 3.
- The use of fluoroquinolones, which are often prescribed for UTIs, is thought to be inappropriately excessive and may have detrimental effects, making MacroBID a potentially better choice for uncomplicated UTIs 4.
Antibiotic Choice and Patient Characteristics
- Patient characteristics, such as older age and presence of diabetes, may be associated with longer treatment durations 5.
- The choice of antibiotic for UTI treatment may depend on patient characteristics, but no specific characteristics have been found to be associated with the use of specific antibiotics, including MacroBID 5.