From the Guidelines
Nitrofurantoin (Macrobid) is not recommended for treating ESBL (Extended-Spectrum Beta-Lactamase) infections, as the provided evidence does not support its use for this indication. The most recent and highest quality study, 1, discusses the treatment of infections caused by multidrug-resistant bacteria, including metallo-β-lactamase (MBL)-producing carbapenem-resistant Enterobacterales (CRE), but does not mention nitrofurantoin as a treatment option.
Key Considerations
- The study 1 recommends the use of ceftazidime/avibactam plus aztreonam or cefiderocol for the treatment of infections caused by MBL-producing CRE, with a strong recommendation for the former and a conditional recommendation for the latter.
- Another study, 1, discusses the management of intra-abdominal infections and recommends carbapenem-sparing treatment, particularly in settings with a high incidence of carbapenem-resistant K. pneumoniae.
- The use of nitrofurantoin is not mentioned in the context of ESBL infections in either study, and its effectiveness against these infections is not established.
Treatment Options
- For uncomplicated urinary tract infections caused by ESBL-producing bacteria, other antibiotics may be effective, but the choice of antibiotic should be guided by culture and susceptibility testing.
- For more severe or complicated ESBL infections, carbapenems or other antibiotics may be necessary, based on susceptibility testing.
- It is essential to note that nitrofurantoin should not be used for systemic infections or pyelonephritis and is contraindicated in patients with significant renal impairment (creatinine clearance <30 mL/min) and should be used cautiously in patients with G6PD deficiency.
Conclusion is not allowed, so the answer just stops here.
From the Research
Treatment of ESBL Infections with Macrobid (Nitrofurantoin)
- Macrobid (Nitrofurantoin) can be used to treat ESBL (Extended-Spectrum Beta-Lactamase) infections, particularly for uncomplicated urinary tract infections (UTIs) 2, 3.
- Studies have shown that nitrofurantoin has a high sensitivity rate against ESBL-producing Enterobacteriaceae, with approximately 93% of E. coli isolates and 42% of Klebsiella species isolates being sensitive to nitrofurantoin 2.
- A study on pediatric patients with acute cystitis caused by ESBL-producing E. coli found that oral nitrofurantoin treatment had a bacteriological response rate of 98% and no significant side effects were observed 3.
- However, it is essential to note that the use of nitrofurantoin for ESBL infections should be guided by susceptibility testing and local resistance patterns 2, 4.
- Other treatment options for ESBL infections include carbapenems, cephamycins, fluoroquinolones, and beta-lactam/beta-lactam inhibitor combinations, which may be more effective for severe or complicated infections 5, 6, 4.