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ContraindicationsĪnuria, oliguria, or significant impairment of renal function (creatinine clearance 6 months) of nitrofurantoin has been associated with diffuse interstitial pneumonitis and/or pulmonary fibrosis, chronic hepatitis, and the development of neuropathy (Holmberg 1980 manufacturer's labeling). Limitations of use: Not indicated for treatment of pyelonephritis or perinephric abscessĬystitis, recurrent, prophylaxis: Nitrofurantoin macrocrystals (Furadantin, Macrodantin): Chronic suppression of recurrent UTIs Use: Off Labelīacteriuria, asymptomatic, in pregnancybyesīased on the Infectious Diseases Society of America clinical practice guideline for the management of asymptomatic bacteriuria, nitrofurantoin is an effective and recommended agent in the management of asymptomatic bacteriuria (≥10 5 CFU per mL) in pregnancy.ĭata from a randomized, controlled trial support the use of nitrofurantoin for the treatment of asymptomatic bacteriuria in pregnancy Lumbiganon 2009. coli, enterococci, Staphylococcus aureus, and certain susceptible strains of Klebsiella and Enterobacter species Nitrofurantoin macrocrystals (Furadantin, Macrodantin): Treatment of acute uncomplicated cystitis when caused by susceptible strains of E. Nitrofurantoin monohydrate/macrocrystals (Macrobid): Treatment of acute uncomplicated cystitis caused by susceptible strains of Escherichia coli or Staphylococcus saprophyticus in patients ≥12 years of age Use: Labeled IndicationsĬystitis, acute uncomplicated, treatment: Macrocrystals: Urine (20% to 25% as unchanged drug) Half-Life EliminationĢ0 to 60 minutes prolonged with renal impairment Protein BindingĦ0% to 90% Use in Specific Populations Special Populations: Renal Function Impairment Suspension: Urine (~40%) and feces (small amounts) as metabolites and unchanged drug Well absorbed macrocrystalline is absorbed more slowly due to slower dissolution (causes less GI distress) Distributionīody tissues (except plasma) metabolize 60% of drug to inactive metabolites Excretion

Pharmacokinetics/Pharmacodynamics Absorption The broad-based nature of this mode of action may explain the lack of acquired bacterial resistance to nitrofurantoin, as the necessary multiple and simultaneous mutations of the target macromolecules would likely be lethal to the bacteria. Nitrofurantoin is bactericidal in urine at therapeutic doses. Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates that inactivate or alter bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis.