From the Guidelines
Nitrofurantoin is an antibiotic primarily used to treat and prevent urinary tract infections (UTIs), with a recommended dose of 100 mg taken orally every 12 hours for 5 days, as supported by the most recent guidelines from the European Association of Urology in 2024 1.
Key Points
- The medication works by damaging bacterial DNA and inhibiting protein synthesis, making it effective against many common urinary pathogens including E. coli.
- Nitrofurantoin concentrates in urine, providing targeted action where needed.
- The medication should be taken with food to improve absorption and reduce stomach upset.
- Common side effects include nausea, vomiting, and loss of appetite.
- Nitrofurantoin should be avoided in patients with creatinine clearance below 30 ml/min, during late pregnancy (38-42 weeks), in nursing mothers, and in those with G6PD deficiency.
Treatment Duration and Dose
- The typical adult dose for acute UTI treatment is 100 mg taken orally every 12 hours for 5 days, as recommended by the European Association of Urology guidelines in 2024 1.
- For prophylaxis, 50-100 mg daily at bedtime is common.
Efficacy and Safety
- Nitrofurantoin has been shown to have similar clinical cure rates to other antibiotics, such as trimethoprim-sulfamethoxazole and fosfomycin, in the treatment of acute uncomplicated cystitis 1.
- The medication has a good safety profile, with common side effects being mild and self-limiting.
Special Considerations
- Patients with creatinine clearance below 30 ml/min should avoid using nitrofurantoin due to the risk of toxicity.
- Pregnant women in the late stages of pregnancy (38-42 weeks) should also avoid using nitrofurantoin due to the risk of harm to the fetus.
- Nursing mothers and patients with G6PD deficiency should also avoid using nitrofurantoin due to the risk of adverse effects.
Monitoring and Follow-up
- Patients should complete the full course of treatment even if symptoms improve quickly to prevent bacterial resistance.
- Long-term use of nitrofurantoin requires monitoring for pulmonary toxicity and liver damage.
From the FDA Drug Label
If the symptoms are not recognized as being drug-related and nitrofurantoin therapy is not stopped, the symptoms may become more severe. The use of Nitrofurantoin is not explicitly stated in the provided text. No direct information about the use of Nitrofurantoin (antibiotic) is available in the given drug label. The FDA drug label does not answer the question.
From the Research
Use of Nitrofurantoin
- Nitrofurantoin is an antibiotic used for the treatment of uncomplicated urinary tract infections (UTI) 2, 3, 4.
- It has been used for over 60 years and has retained good activity against Escherichia coli and other pathogens of uncomplicated UTI 2.
- Nitrofurantoin is recommended as a first-line antibiotic for the empiric treatment of uncomplicated cystitis in otherwise healthy women 2.
Efficacy and Safety
- Studies have shown that short-term nitrofurantoin therapy is effective and well-tolerated, with efficacy comparable to other standard therapeutic regimens 2, 4.
- A 5-day course of nitrofurantoin has been shown to be equivalent to a 3-day course of trimethoprim-sulfamethoxazole in terms of clinical and microbiological cure rates 4.
- However, nitrofurantoin therapy can be accompanied by adverse drug effects, including serious side effects such as pulmonary reactions and polyneuropathy, which mainly occur with long-term use 2.
Prophylaxis and Renal Function
- Nitrofurantoin is also used for the prophylaxis of recurrent UTI, with a recommended daily dose of 50 mg or 100 mg 5.
- A study found that 50 mg daily prophylaxis was associated with a lower hazard of adverse events, such as cough, dyspnea, and nausea, compared to 100 mg daily prophylaxis 5.
- Renal function should be considered in the clinical decision-making for cystitis treatment, as nitrofurantoin may be less effective in patients with impaired renal function 6.