Yes, Continue Macrobid for Staphylococcus saprophyticus UTI
You should continue taking Macrobid (nitrofurantoin) for your Staphylococcus saprophyticus urinary tract infection, as this organism is inherently susceptible to nitrofurantoin and responds well to standard treatment without requiring susceptibility testing. 1, 2
Why Nitrofurantoin Works for S. saprophyticus
S. saprophyticus remains highly susceptible to nitrofurantoin despite decades of use, making it an excellent first-line choice for uncomplicated UTIs caused by this organism 3, 4
The CLSI specifically states that routine susceptibility testing is unnecessary for S. saprophyticus urinary isolates because these infections respond to urinary concentrations of nitrofurantoin, fluoroquinolones, and trimethoprim-sulfamethoxazole 5, 4
Nitrofurantoin maintains activity against S. saprophyticus along with other common UTI pathogens including E. coli and Enterococcus species, even after 60+ years of clinical use 4, 6
Recommended Treatment Duration
Complete a 5-day course of nitrofurantoin 100 mg twice daily for your uncomplicated cystitis, as recommended by multiple guideline societies including the Infectious Diseases Society of America and American College of Physicians 1, 7, 2
Do not extend treatment beyond 7 days unless symptoms persist, as shorter courses minimize adverse effects while maintaining efficacy 1
Important Safety Considerations
Ensure your kidney function is adequate (creatinine clearance ≥60 mL/min), as nitrofurantoin is contraindicated with lower renal function due to inadequate urinary drug concentrations and increased toxicity risk 7, 8
Monitor for serious adverse effects including pulmonary reactions (cough, shortness of breath), peripheral neuropathy (numbness, tingling in extremities), and hepatotoxicity, though these are rare with short-term use 8
Stop the medication immediately and contact your physician if you develop difficulty breathing, persistent cough, numbness/tingling in hands or feet, or signs of liver problems (jaundice, dark urine, severe fatigue) 8
When to Seek Follow-up
No routine post-treatment testing is needed if your symptoms completely resolve by the end of treatment 2
Return for urine culture with susceptibility testing if symptoms do not resolve by day 5-7 or recur within 2 weeks of completing treatment 2
Consider a 7-day course with an alternative agent if initial treatment fails, based on culture results 2