From the Guidelines
When taking Macrobid (nitrofurantoin monohydrate), a urinary tract infection (UTI) antibiotic, supplementation with Lactobacillus species is not routinely recommended. However, patients taking Macrobid for extended durations (typically greater than 7-10 days) may benefit from concurrent probiotic therapy with Lactobacillus acidophilus or Lactobacillus rhamnosus to mitigate potential disruptions to the gastrointestinal microbiome, as suggested by studies on antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea 1.
Key Considerations
- A typical dose of 1-2 billion CFU per day of Lactobacillus species may be considered, but this should be individualized based on patient-specific factors and clinical judgment.
- The use of probiotics, including Lactobacillus species, has been shown to reduce the risk of Clostridium difficile infection in patients taking antibiotics, particularly those with high risk of developing the infection 1.
- The American Gastroenterological Association (AGA) suggests the use of certain strains and strain combinations of probiotics, including Lactobacillus acidophilus, in the prevention of Clostridium difficile infection, although the quality of evidence is low 1.
Probiotic Strains and Dosages
- Lactobacillus acidophilus and Lactobacillus rhamnosus are among the probiotic strains that have been studied for their potential benefits in preventing antibiotic-associated diarrhea and Clostridium difficile infection.
- The optimal dosage and strain of probiotics for preventing Clostridium difficile infection are not well established, and further studies are needed to determine the most effective probiotic regimens 1.
From the Research
Lactobacillus and Macrobid (Nitrofurantoin) Interaction
- There is no direct evidence in the provided studies to suggest that Lactobacillus is necessary when taking Macrobid (Nitrofurantoin) 2, 3, 4, 5, 6.
- The studies focus on the efficacy of Nitrofurantoin in treating urinary tract infections (UTIs) and its pharmacological properties, but do not mention the role of Lactobacillus in conjunction with Nitrofurantoin therapy.
Nitrofurantoin Efficacy and Safety
- Nitrofurantoin has been shown to be effective in treating UTIs, including those caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli 5.
- The drug has a good safety profile, with few adverse events reported, primarily gastrointestinal symptoms such as nausea and diarrhea 2, 5.
- Nitrofurantoin is recommended as a first-line treatment for uncomplicated UTIs in some guidelines, although the optimal duration of treatment is still a topic of debate 4.
Treatment of UTIs with Nitrofurantoin
- Nitrofurantoin has been used to treat various types of UTIs, including those caused by Aerococcus urinae and Aerococcus sanguinicola 6.
- The drug has been shown to achieve clinical and microbiological success in a significant proportion of patients with UTIs, including those with cystitis and pyelonephritis 2, 6.