Nitrofurantoin: Effective Treatment for Urinary Tract Infections
Nitrofurantoin
| Product dosage: 100mg | |||
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| 500 | $0.51
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| Product dosage: 50mg | |||
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| 400 | $0.45 | $232.00 $178.00 (23%) | 🛒 Add to cart |
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Synonyms
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Nitrofurantoin is a prescription antibacterial medication specifically indicated for the treatment and prophylaxis of uncomplicated urinary tract infections (UTIs) caused by susceptible strains of Escherichia coli, Enterococcus faercium, Staphylococcus saprophyticus, Enterobacter species, and Klebsiella species. As a nitrofuran derivative, it exerts its bactericidal effect by interfering with bacterial enzyme systems, including acetyl coenzyme A, thereby inhibiting bacterial cell wall synthesis, carbohydrate metabolism, DNA and RNA formation, and other vital processes. Its unique pharmacokinetic profile results in high concentrations in the urine and renal tissue, with minimal systemic absorption, making it an ideal agent for targeting pathogens within the urinary tract while limiting broader ecological impact. Clinicians value nitrofurantoin for its well-established efficacy, favorable safety profile when used appropriately, and its role as a first-line option in an era of increasing antimicrobial resistance.
Features
- Contains nitrofurantoin monohydrate/macrocrystals as the active pharmaceutical ingredient
- Available in oral capsule formulations (25 mg, 50 mg, 100 mg) and suspension
- Macrocrystalline structure designed for improved gastrointestinal tolerance
- Bactericidal activity against common uropathogens
- Low systemic absorption with high urinary concentration
- Pregnancy Category B (macrocrystalline formulation)
- Multiple generic and brand-name versions available (e.g., Macrobid, Macrodantin)
Benefits
- Provides targeted treatment for lower urinary tract infections with minimal impact on gut flora
- Demonstrated efficacy against many antibiotic-resistant uropathogens
- Suitable for long-term prophylaxis in patients with recurrent UTIs
- Lower risk of Clostridium difficile infection compared to broad-spectrum antibiotics
- Established safety profile with decades of clinical use
- Cost-effective treatment option available in multiple formulations
Common use
Nitrofurantoin is primarily prescribed for the treatment of acute, uncomplicated urinary tract infections (cystitis) caused by susceptible strains of bacteria. Its use is particularly valuable in cases where first-line agents like trimethoprim-sulfamethoxazole cannot be used due to resistance or patient intolerance. The medication is also commonly employed for long-term suppressive therapy in patients experiencing recurrent UTIs, typically at a reduced dosage frequency. Off-label uses may include treatment of some gastrointestinal infections caused by susceptible organisms, though evidence for these applications is more limited. Clinical practice guidelines from infectious disease societies consistently include nitrofurantoin among recommended agents for uncomplicated UTI management in appropriate patient populations.
Dosage and direction
For acute cystitis treatment:
- Adults: 100 mg twice daily for 5 days (macrocrystals formulation) or 50-100 mg four times daily for 7 days (monohydrate/macrocrystals)
- Children over 12 years: 100 mg twice daily for 5-7 days
- Children 1-12 years: 5-7 mg/kg/day divided into 4 doses (maximum 400 mg/day)
For chronic suppression:
- Adults: 50-100 mg once daily at bedtime
- Children: 1-2 mg/kg once daily (maximum 100 mg/day)
Administration should occur with food or milk to enhance absorption and minimize gastrointestinal upset. The medication should be swallowed whole with a full glass of water. For optimal efficacy, patients should maintain adequate hydration during treatment. Dosage adjustment is required in patients with renal impairment (creatinine clearance <60 mL/min) due to reduced urinary concentration and increased risk of toxicity.
Precautions
Patients should be counseled to complete the full course of therapy even if symptoms improve rapidly. Pulmonary reactions, including acute, subacute, and chronic pulmonary syndromes, may occur and require immediate medical attention if symptoms such as cough, chest pain, or dyspnea develop. Hepatic reactions, including hepatitis and cholestatic jaundice, have been reported and necessitate monitoring for symptoms of liver dysfunction. Peripheral neuropathy, which may become severe or irreversible, has been associated with nitrofurantoin use, particularly in patients with renal impairment, anemia, diabetes, electrolyte imbalance, vitamin B deficiency, or debilitating disease. Hemolytic anemia may occur in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Superinfections with nonsusceptible organisms, including fungi, may develop and require appropriate therapy.
Contraindications
Nitrofurantoin is contraindicated in patients with known hypersensitivity to nitrofurantoin or other nitrofuran derivatives. It should not be used in patients with significant renal impairment (creatinine clearance <60 mL/min) due to inadequate drug delivery to the urinary tract and increased risk of systemic toxicity. The medication is contraindicated in pregnant patients at term (38-42 weeks gestation), during labor and delivery, or when the onset of labor is imminent due to risk of hemolytic anemia in the neonate. It should not be used in infants younger than one month old due to risk of hemolytic anemia. Patients with a history of cholestatic jaundice or hepatic dysfunction associated with prior nitrofurantoin use should not receive the drug.
Possible side effect
Common (≥1%):
- Gastrointestinal: nausea, vomiting, abdominal pain, diarrhea, anorexia
- Neurological: headache, dizziness
- Miscellaneous: discoloration of urine (brownish-yellow)
Less common (0.1-1%):
- Pulmonary: cough, dyspnea, chest pain, pulmonary infiltration
- Hepatic: elevated liver enzymes, hepatitis, jaundice
- Hematological: megaloblastic anemia, leukopenia, thrombocytopenia
- Dermatological: rash, pruritus, urticaria, angioedema
- Neurological: peripheral neuropathy, drowsiness
Rare (<0.1%):
- Anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis
- Pancreatitis, Clostridium difficile-associated diarrhea
- Optic neuritis, intracranial hypertension
- Photosensitivity reactions, alopecia
Drug interaction
Nitrofurantoin may interact with several classes of medications:
- Probenecid: Decreases renal excretion of nitrofurantoin, potentially increasing systemic exposure and toxicity while reducing urinary concentrations and efficacy
- Antacids containing magnesium trisilicate: May reduce absorption and bioavailability of nitrofurantoin
- Uricosuric agents: May alter excretion patterns
- Drugs that cause peripheral neuropathy: May have additive neurotoxic effects (e.g., disulfiram, metronidazole)
- Oral contraceptives: Theoretical potential for reduced efficacy, though evidence is limited
- Sulfinpyrazone: May inhibit renal secretion of nitrofurantoin
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. For those on prophylactic therapy, consistency in timing is less critical than with acute treatment regimens, but maintaining regular administration helps ensure adequate urinary concentrations.
Overdose
Acute overdose may manifest as vomiting, nausea, and diarrhea. There is no specific antidote for nitrofurantoin overdose. Management should include gastric lavage if presentation is early after ingestion, along with supportive measures including maintenance of hydration and electrolyte balance. Hemodialysis may be of limited value due to nitrofurantoin’s low plasma protein binding and rapid elimination, but may be considered in severe cases. For chronic overdose, manifestations may include peripheral neuropathy, hepatic toxicity, or pulmonary reactions requiring appropriate symptomatic management and drug discontinuation.
Storage
Nitrofurantoin should be stored at controlled room temperature (20-25°C or 68-77°F) in its original container, protected from light and moisture. The medication should be kept out of reach of children and pets. Unused medication should be properly disposed of according to local regulations once treatment is completed or if the product has expired. The suspension formulation requires particular attention to expiration dates and storage conditions once reconstituted.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient circumstances may vary, and healthcare professionals should exercise clinical judgment when prescribing nitrofurantoin. The prescribing information approved by regulatory authorities should be consulted for complete details regarding indications, dosing, contraindications, warnings, and precautions. Patients should not make changes to their medication regimen without consulting their healthcare provider.
Reviews
Clinical studies consistently demonstrate nitrofurantoin’s efficacy in treating uncomplicated UTIs, with clinical success rates typically exceeding 85-90% for susceptible organisms. The 5-day course of the macrocrystalline formulation shows comparable efficacy to longer courses of other agents with generally favorable tolerability. For prophylaxis, nitrofurantoin has demonstrated significant reduction in UTI recurrence rates (typically 70-90% reduction) with long-term safety data supporting its use for up to 12 months or longer in appropriate patients. While gastrointestinal side effects remain the most common reason for discontinuation, the macrocrystalline formulation has shown improved tolerability compared to earlier formulations. Emerging resistance patterns continue to show favorable susceptibility profiles for nitrofurantoin against common uropathogens compared to other oral agents.