Nitrofurantoin
Elderly. Monitor hepatic and pulmonary function during prolonged therapy. Pre-existing pulmonary, hepatic, neurological, or allergic disorders, predisposition to peripheral neuropathy e.g. renal impairment, anaemia, DM, electrolyte imbalance, debility, vitamin B deficiency. Withdraw if signs of peripheral neuropathy occur. Lactation. Lactation: Enters breast milk; discontinue drug or do not nurse
Uncomplicated UTI, Urinary Tract Infection
Severe renal impairment (anuria, oliguria, significantly elevated serum creatinine, CrCl <60 ml/min). Hypersensitivity to nitrofurans, G6PD deficiency, infants <3 mth. Pregnancy at term, during labour and delivery, or when the onset of labour is imminent.
N/A
Nausea, vomiting, anorexia, abdominal pain, diarrhoea; headache, drowsiness, vertigo, dizziness, nystagmus, benign intracranial hypertension; rash, urticaria, pruritus, fever, sialadenitis, angioedema, erythema multiforme, exfoliative dermatitis, pancreatitis, lupus-like syndrome, myalgia, arthralgia; acute pulmonary sensitivity reactions; megaloblastic anaemia, leucopenia, granulocytopenia or agranulocytosis, thrombocytopenia, aplastic anaemia, haemolytic anaemia (in G6PD-deficient patients); transient alopecia; brownish discolouration of urine. Potentially Fatal: Peripheral polyneuropathy, hepatotoxicity, anaphylaxis, Stevens-Johnson syndrome, interstitial pneumonitis, pulmonary fibrosis.
Nitrofurantoin interferes with cell metabolism and cell wall synthesis by inhibiting several enzyme systems including acetyl coenzyme A. It is bactericidal to most gram-positive and gram-negative urinary tract pathogens.
Reduced excretion with probenecid or sulfinpyrazone. Absorption reduced by magnesium trisilicate. Antagonistic effects with quinolone antibacterials. Reduced effects with carbonic anhydrase inhibitors or urinary alkalinisers.
N/A
Oral Acute uncomplicated urinary tract infections Adult: 50-100 mg 4 times daily for 7 days or for 3 days after obtaining sterile urine. SR preparation: 100 mg bid for 7 days or for 3 days after obtaining sterile urine. Prophylaxis of uncomplicated urinary tract infections Adult: 50-100 mg at bedtime for up to 12 months.
Urinary Tract Infection >1 month 5-7 mg/kg/day PO divided q6hr for 7 days UTI prophylaxis: 1-2 mg/kg PO qHS or 2 divided doses >12 years 50-100 mg PO q6hr for 7 days or for 3 days after obtaining sterile urine SR preparation: 100 mg PO q12hr for 7 days or for 3 days after obtaining sterile urine Long-term prophylaxis/suppression: 50-100 mg PO at bedtime for up to 12 months
Loses effectiveness in patients with CrCl <60 mL/min due to inadequate urine concentration Monitor renal function; renally excreted; decreased renal function more likely in elderly
Should be taken with food. Take w/ or immediately after meals. Sustained release macrocrystals indicated only for patients >12 years for acute UTIs (cystitis) caused by E coli or S saprophyticus
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