From the Guidelines
Macrobid (Nitrofurantoin) is not typically recommended for the treatment of pyelonephritis.
Rationale
- The evidence suggests that for patients with pyelonephritis, TMP/SMX or a first-generation cephalosporin represent reasonable first-line agents, but should be dependent upon local resistance rates 1.
- Fluoroquinolones are also a recommended option for the treatment of pyelonephritis, with a treatment duration of 5 to 7 days 1.
- Nitrofurantoin is generally recommended for the treatment of uncomplicated cystitis, with a treatment duration of 5 days 1.
- The use of nitrofurantoin for pyelonephritis is not well supported by the evidence, and it is not typically recommended for this indication 1.
Key Points
- Pyelonephritis requires a different treatment approach than uncomplicated cystitis.
- TMP/SMX, first-generation cephalosporins, and fluoroquinolones are recommended options for the treatment of pyelonephritis.
- Nitrofurantoin is not typically recommended for the treatment of pyelonephritis.
- Treatment duration and choice of antibiotic should be based on local resistance rates and patient-specific factors 1.
From the Research
Effectiveness of Macrobid (Nitrofurantoin) in Treating Pyelonephritis
- The effectiveness of nitrofurantoin in suppressing bacterial growth in the urinary tract, including pyelonephritis, was evaluated in a study published in 1969 2.
- The study found that nitrofurantoin was effective in preventing ascending pyelonephritis and suppressing bacterial multiplication in kidney tissue.
- A more recent study published in 2014 discussed the clinical relevance of nitrofurantoin in treating uncomplicated urinary tract infections, including pyelonephritis 3.
- The study noted that nitrofurantoin has been recommended as a first-line antibiotic for the empiric treatment of uncomplicated cystitis and pyelonephritis in women.
- Another study published in 2021 compared the risk of treatment failure of different antibiotic regimens, including nitrofurantoin, in treating uncomplicated urinary tract infections 4.
- The study found that the risk of pyelonephritis was lower for nitrofurantoin compared to other antibiotics, such as trimethoprim-sulfamethoxazole.
- A 2022 study compared the effectiveness and safety of 100 mg and 50 mg daily doses of nitrofurantoin in preventing urinary tract infections, including pyelonephritis 5.
- The study found that both doses were effective in preventing UTIs, but the 50 mg dose had a better safety profile.
Coverage of Pyelonephritis by Macrobid (Nitrofurantoin)
- The studies suggest that Macrobid (Nitrofurantoin) is effective in covering pyelonephritis, although the effectiveness may vary depending on the dose and the specific strain of bacteria causing the infection 2, 3, 4, 5.
- A 2018 study compared the in vitro effectiveness of nitroxoline and nitrofurantoin against various bacterial strains, including those that cause pyelonephritis 6.
- The study found that nitroxoline had a broader antimicrobial spectrum and was non-inferior to nitrofurantoin against certain bacterial strains.