From the Research
No, nitrofurantoin does not cover Pseudomonas aeruginosa urinary tract infections (UTIs). Nitrofurantoin is an oral antibiotic that is effective against many common UTI pathogens including Escherichia coli, Enterococcus, Staphylococcus saprophyticus, and some Klebsiella species, but it lacks activity against Pseudomonas aeruginosa 1. For Pseudomonas UTIs, alternative antibiotics such as fluoroquinolones (ciprofloxacin, levofloxacin), certain cephalosporins (ceftazidime, cefepime), carbapenems (meropenem), or piperacillin-tazobactam would be more appropriate choices depending on susceptibility testing.
Some key points to consider when treating Pseudomonas UTIs include:
- The use of ceftolozane-tazobactam or ceftazidime-avibactam as empirical treatment for suspected Pseudomonas infections based on local epidemiology and risk factors 2
- The importance of antibiotic de-escalation after antimicrobial susceptibility tests suggest it is appropriate 2
- The potential use of cefiderocol and imipenem-cilastatin-relebactam in cases with resistance to other new antibiotics 2
Pseudomonas aeruginosa has intrinsic resistance mechanisms including efflux pumps and low outer membrane permeability that render nitrofurantoin ineffective against this organism. When treating a suspected or confirmed Pseudomonas UTI, it's essential to select an antibiotic with known activity against this pathogen and to guide therapy based on culture and sensitivity results whenever possible.
In terms of the most recent and highest quality evidence, a 2023 review of evidence-based treatment of Pseudomonas aeruginosa infections highlights the importance of wise treatment choices and the use of newer antibiotics sparingly 2. This review, along with other recent studies 1, 3, supports the conclusion that nitrofurantoin is not effective against Pseudomonas aeruginosa and that alternative antibiotics should be used to treat Pseudomonas UTIs.