From the Guidelines
Citralka and nitrofurantoin should not be given together. Citralka is an alkalinizing agent that increases urinary pH, while nitrofurantoin requires an acidic urine environment (pH below 5.5) to be effective against urinary tract infections. When these medications are administered concurrently, Citralka will reduce the antibacterial activity of nitrofurantoin by creating an alkaline urine environment. This interaction significantly compromises the therapeutic efficacy of nitrofurantoin.
Key Points to Consider
- If nitrofurantoin is prescribed for a urinary tract infection, patients should avoid taking urinary alkalinizers like Citralka, potassium citrate, or sodium bicarbonate during the course of antibiotic treatment.
- Patients requiring nitrofurantoin should also avoid foods and beverages that alkalinize urine.
- If urinary alkalinization is necessary for another condition, an alternative antibiotic that is not affected by urinary pH should be selected instead of nitrofurantoin.
Relevant Guidelines and Recommendations
According to the guidelines and recommendations from various studies, including those published in the Journal of Microbiology, Immunology and Infection 1, and the Annals of Internal Medicine 1, nitrofurantoin is recommended for the treatment of uncomplicated urinary tract infections. However, there is no mention of the use of Citralka with nitrofurantoin in these guidelines.
Clinical Implications
The use of Citralka with nitrofurantoin can lead to reduced efficacy of the antibiotic, which can result in treatment failure and the development of antibiotic-resistant bacteria. Therefore, it is essential to avoid the concurrent use of these medications to ensure the effective treatment of urinary tract infections.
Alternative Options
If urinary alkalinization is necessary for another condition, alternative antibiotics that are not affected by urinary pH, such as trimethoprim-sulfamethoxazole or fosfomycin, can be considered instead of nitrofurantoin 1.
From the Research
Nitrofurantoin and Citralka Interaction
- There are no research papers to assist in answering this question regarding the interaction between citralka and nitrifurantoin.
Nitrofurantoin Efficacy and Safety
- Nitrofurantoin has been used for the prevention of urinary tract infection (UTI) for over 60 years, with studies showing its efficacy and safety in this context 2.
- A systematic review and meta-analysis found that nitrofurantoin is effective in the prevention of UTI, with a risk ratio of 0.38 in favor of nitrofurantoin compared to no prophylaxis 2.
- The same study found that nitrofurantoin's prophylactic efficacy is superior to that of methenamine hippurate and comparable to that of other antibacterials 2.
- However, the use of nitrofurantoin may be associated with increased non-severe adverse effects, with severe adverse effects occurring infrequently 2.
Nitrofurantoin Dosage and Exposure
- A study found that the urine nitrofurantoin exposure was not affected by age and eGFR, and that the data obtained do not support the discouragement of nitrofurantoin use in the elderly and in patients with impaired renal function 3.
- The study also found that the nitrofurantoin exposure was similar for patients receiving 50 mg q6h and those treated with 100 mg q12h 3.
Nitrofurantoin Treatment Effect
- A systematic review and meta-analysis estimated the treatment effect of nitrofurantoin for a non-inferiority trial in uncomplicated urinary tract infection, finding a microbiological response rate of 0.766 (0.665-0.867) for nitrofurantoin and 0.342 (0.288-0.397) for placebo 4.
- The corresponding treatment effect estimate for nitrofurantoin was 26.8%, which supports a conservative non-inferiority margin of 12.5% 4.