Is Macrobid (Nitrofurantoin) safe in patients with Diabetes Mellitus?

From the Guidelines

Macrobid (Nitrofurantoin) is safe to use in patients with Diabetes Mellitus. According to the guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults 1, there is no evidence to suggest that Macrobid is harmful to patients with diabetes. In fact, a prospective, cohort study of diabetic women reported no differences in rates of symptomatic urinary infection, mortality, or progression to diabetic complications between initially bacteriuric and nonbacteriuric women at 18 months or 14 years of follow-up 1.

• The American guidelines recommend against screening for or treatment of asymptomatic bacteriuria in diabetic women 1, which implies that the use of Macrobid in this population is not associated with significant risks.
• A rapid review with practice recommendations for the treatment and prevention of recurrent lower urinary tract infections in women suggests that nitrofurantoin is a preferred antibiotic choice, taking into account patient’s prior organism identification and susceptibility profile, drug allergies, and antibiotic stewardship 2.
• However, it is essential to consider the patient's individual factors, such as prior organism identification and susceptibility profile, drug allergies, and antibiotic stewardship, when selecting an antibiotic regimen.
• Additionally, behavioral/lifestyle modifications, such as controlling blood glucose levels, maintaining adequate hydration, and voiding after intercourse, can help prevent urinary tract infections in patients with diabetes 2.

From the FDA Drug Label

Neurologic: Peripheral neuropathy, which may become severe or irreversible, has occurred Fatalities have been reported. Conditions such as renal impairment (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine), anemia, diabetes mellitus, electrolyte imbalance, vitamin B deficiency, and debilitating diseases may increase the possibility of peripheral neuropathy (see WARNINGS)

• Diabetes Mellitus is listed as a condition that may increase the possibility of peripheral neuropathy in patients taking Nitrofurantoin.
• The presence of Diabetes Mellitus may require cautious use of Nitrofurantoin due to the potential increased risk of peripheral neuropathy.
• It is recommended to carefully weigh the benefits and risks of using Nitrofurantoin in patients with Diabetes Mellitus and to monitor for signs of peripheral neuropathy 3.

From the Research

Safety of Macrobid (Nitrofurantoin) in Patients with Diabetes Mellitus

• The safety and efficacy of Macrobid (Nitrofurantoin) in patients with Diabetes Mellitus have been evaluated in several studies 4, 5, 6, 7, 8.
• A study published in JAMA in 2014 found that nitrofurantoin is an appropriate first-line therapy for uncomplicated cystitis in women, including those with diabetes 4.
• Another study published in 2006 found that nitrofurantoin is effective in treating chronic urinary tract infections in patients with type 2 diabetes mellitus, with no significant differences in therapeutic successes compared to cotrimoxazole 5.
• A review published in the International Journal of Antimicrobial Agents in 2008 noted that patients with diabetes mellitus have a higher prevalence of asymptomatic bacteriuria and urinary tract infections, and recommended considering these patients as having complicated UTIs, with treatment durations of 7-14 days 6.
• A study published in the Journal of Diabetes and its Complications in 2013 found that treatment with dapagliflozin, an SGLT2 inhibitor, was associated with a slightly increased risk of urinary tract infections, but most infections were mild to moderate and clinically manageable 7.
• A retrospective cohort study published in 2022 found no clinically significant difference in treatment failure between 5-day and 7-day courses of nitrofurantoin for urinary tract infections in women with diabetes, suggesting that a 5-day treatment may be considered to reduce cumulative nitrofurantoin exposure in patients with diabetes mellitus 8.

Key Findings

• Nitrofurantoin is effective and safe for use in patients with diabetes mellitus 4, 5, 8.
• Patients with diabetes mellitus may require longer treatment durations for urinary tract infections 6.
• The risk of urinary tract infections may be increased with certain medications, such as SGLT2 inhibitors 7.
• A 5-day course of nitrofurantoin may be sufficient for treating urinary tract infections in women with diabetes, reducing cumulative exposure to the medication 8.