From the Guidelines
Coagulase-negative Staphylococcus generally responds to nitrofurantoin, making it an effective treatment option for urinary tract infections caused by these organisms. The recommended dose of nitrofurantoin for uncomplicated urinary tract infections is 100 mg orally every 6 hours, as suggested by recent guidelines 1. Nitrofurantoin works by damaging bacterial DNA and inhibiting protein synthesis, and it achieves high concentrations in urine, making it particularly effective for urinary tract infections. Most CoNS strains remain susceptible to nitrofurantoin, even when they show resistance to other antibiotics like beta-lactams.
Key Considerations
- Nitrofurantoin should not be used in patients with creatinine clearance below 60 mL/min, during pregnancy at term (38-42 weeks), in nursing mothers, or in patients with G6PD deficiency.
- While nitrofurantoin is effective against CoNS in the urinary tract, it should not be used for systemic infections as it doesn't achieve adequate blood levels.
- The treatment duration is dependent on the site of infection and clinical response, and it's essential to monitor the patient's condition and adjust the treatment plan accordingly.
Treatment Options
- For uncomplicated UTIs, nitrofurantoin can be prescribed at a dose of 100 mg orally every 6 hours for 5-7 days.
- For prophylaxis, the standard dose is 50-100 mg at bedtime.
- For Macrobid (the macrocrystal form), the standard dose is 100 mg twice daily with food to enhance absorption. It's crucial to note that the guidelines 1 provide recommendations for the treatment of infections due to multidrug-resistant organisms, and nitrofurantoin is recommended for uncomplicated urinary tract infections due to VRE, which may also be applicable to CoNS infections. However, it's essential to consider the specific circumstances of each patient and adjust the treatment plan accordingly.
From the Research
Effectiveness of Nitrofurantoin Against Coagulase-Negative Staphylococcus
- The provided studies do not specifically address the effectiveness of Nitrofurantoin against Coagulase-negative (Coag neg) Staphylococcus 2, 3, 4, 5, 6.
- However, some studies mention the efficacy of Nitrofurantoin against various pathogens, including Staphylococcus saprophyticus and Enterococcus species 2, and Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) 4.
- There is no direct evidence in the provided studies to confirm whether Coagulase-negative Staphylococcus responds to Nitrofurantoin.
General Efficacy of Nitrofurantoin
- Nitrofurantoin has been shown to be effective against common uropathogens, with clinical cure rates varying between 79% and 92% 5.
- The antibiotic has been recommended as a first-line treatment for uncomplicated lower urinary tract infections (UTIs) due to its good clinical and microbiological efficacy 2, 5.
- However, its use is contraindicated in certain cases, such as in the last three months of pregnancy and in patients with renal impairment of any degree 2.