Nitrofurantoin: Effective Treatment for Urinary Tract Infections
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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, Staphylococcus aureus, certain strains of Klebsiella and Enterobacter species. As a nitrofuran derivative, it exerts its bactericidal effect by interfering with bacterial enzyme systems and cell wall synthesis. Its unique pharmacokinetic profile ensures high concentrations in the urine with minimal systemic absorption, making it a targeted therapy for lower urinary tract infections. Healthcare providers frequently prescribe nitrofurantoin due to its efficacy, well-established safety profile when used appropriately, and its role in combating bacterial resistance patterns.
Features
- Active ingredient: Nitrofurantoin (available as macrocrystals or monohydrate/macrocrystals)
- Mechanism of action: Inhibition of bacterial acetylcoenzyme A, disrupting cell wall synthesis and other vital enzymatic processes
- Formulations: Oral capsules (25 mg, 50 mg, 100 mg) and oral suspension
- Spectrum of activity: Primarily effective against Gram-positive and Gram-negative uropathogens
- Specialized delivery systems: Macrocrystalline form for improved gastrointestinal tolerance
- Pregnancy category: B (for specific formulations and trimesters, under medical supervision)
Benefits
- Provides targeted bactericidal action within the urinary tract with minimal systemic exposure
- Effective against many antibiotic-resistant uropathogens, making it valuable in era of increasing resistance
- Suitable for both acute treatment and long-term prophylaxis of recurrent UTIs
- Well-established safety profile with decades of clinical use and documentation
- Lower risk of disrupting gut microbiota compared to broad-spectrum antibiotics
- Cost-effective therapeutic option with multiple generic formulations available
Common use
Nitrofurantoin is primarily prescribed for the management of acute uncomplicated cystitis caused by susceptible strains of bacteria. It is particularly useful in treating community-acquired UTIs in non-pregnant women. The medication is also employed as prophylactic therapy for patients experiencing recurrent urinary tract infections, typically administered at a reduced dosage for extended periods. Clinical guidelines from infectious disease societies frequently recommend nitrofurantoin as first-line therapy for uncomplicated UTIs due to its targeted spectrum and favorable resistance profile. It is not indicated for the treatment of pyelonephritis or perinephric abscesses due to inadequate tissue penetration.
Dosage and direction
For acute uncomplicated UTIs in adults and children ≥12 years: 50-100 mg orally four times daily with food or milk for 7 days (or 5 days for macrocrystal formulation). For long-term prophylaxis: 50-100 mg orally once daily at bedtime. Pediatric dosing (children >1 month): 5-7 mg/kg/day divided into four doses. Administration with food or milk enhances absorption and reduces gastrointestinal upset. The macrocrystalline formulation may be better tolerated than the microcrystalline form. Complete the full prescribed course even if symptoms improve earlier to prevent recurrence and resistance development. Dosage adjustment is required in patients with renal impairment (CrCl <60 mL/min).
Precautions
Nitrofurantoin is contraindicated in patients with significant renal impairment (creatinine clearance <60 mL/min) due to reduced drug excretion and effectiveness. Use with caution in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to risk of hemolytic anemia. Pulmonary reactions, including acute, subacute, and chronic pulmonary infiltrates and fibrosis, may occur with short-term and long-term therapy. Hepatic reactions, including hepatitis and cholestatic jaundice, have been reported. Peripheral neuropathy, which may become severe or irreversible, has occurred. Superinfections with nonsusceptible organisms, particularly fungi, may develop. Monitor complete blood counts, renal function, and liver function periodically during prolonged therapy.
Contraindications
- Patients with known hypersensitivity to nitrofurantoin or other nitrofuran derivatives
- Significant renal impairment (creatinine clearance <60 mL/min)
- Infants under one month of age due to risk of hemolytic anemia
- Pregnancy at term (38-42 weeks gestation) and during labor and delivery
- Patients with history of cholestatic jaundice or hepatic dysfunction associated with nitrofurantoin
- Known G6PD deficiency (relative contraindication requiring careful risk-benefit assessment)
Possible side effect
Common side effects (≥1%) include nausea, vomiting, anorexia, abdominal pain, diarrhea, and headache. Less frequent adverse reactions include pulmonary manifestations (cough, chest pain, dyspnea, pulmonary infiltrates), hypersensitivity reactions (rash, pruritus, urticaria), drowsiness, dizziness, and vertigo. Serious but rare side effects include Clostridium difficile-associated diarrhea, hepatic toxicity, hemolytic anemia, megaloblastic anemia, peripheral neuropathy, and Stevens-Johnson syndrome. Pancreatitis, arthralgia, and photosensitivity reactions have been reported. Most side effects are dose-related and reversible upon discontinuation of therapy.
Drug interaction
Antacids containing magnesium trisilicate may reduce nitrofurantoin absorption and efficacy. Probenecid and sulfinpyrazone may inhibit renal tubular secretion of nitrofurantoin, increasing serum levels and toxicity risk while decreasing urinary concentrations. Drugs that cause renal impairment may alter nitrofurantoin excretion. Nitrofurantoin may antagonize the antibacterial effect of norfloxacin. Concurrent use with other drugs associated with pulmonary toxicity may increase risk of adverse pulmonary reactions. Live bacterial vaccines may have reduced efficacy during nitrofurantoin therapy. Monitor patients receiving concomitant neurotoxic drugs for enhanced neurotoxic effects.
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain regular dosing intervals to ensure consistent urinary drug concentrations. For patients on prophylactic regimens, occasional missed doses are less critical than during active treatment courses, but consistent adherence is recommended for optimal preventive效果.
Overdose
Acute overdose may manifest as vomiting. No specific antidote exists. Management involves gastric lavage if ingestion was recent and supportive care. Hemodialysis may be of limited value due to nitrofurantoin’s rapid elimination and protein binding. Chronic overdose may lead to peripheral neuropathy or pulmonary reactions. Symptomatic treatment and drug discontinuation are indicated. Monitor for and treat potential complications such as hemolytic anemia in susceptible individuals. Contact poison control center for latest management recommendations.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in original container. Protect from light and moisture. Keep tightly closed. Do not store in bathroom medicine cabinet due to humidity fluctuations. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly dispose of unused medication through medication take-back programs or according to FDA guidelines.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting, changing, or stopping any medication. The prescribing physician should be aware of the patient’s complete medical history, current medications, and allergies. Dosage and treatment duration should be individualized based on clinical presentation, renal function, and microbial susceptibility patterns. Actual product labeling and prescribing information may vary between manufacturers and regions.
Reviews
Clinical studies consistently demonstrate nitrofurantoin’s efficacy in treating uncomplicated UTIs, with clinical success rates exceeding 85% in susceptible infections. The Cochrane Database systematic reviews confirm its effectiveness for both treatment and prevention of recurrent UTIs. Many clinicians appreciate its narrow spectrum and lower ecological impact compared to fluoroquinolones. Patient reviews often mention rapid symptom relief within 24-48 hours, though gastrointestinal side effects are frequently reported. Long-term users on prophylaxis report significant reduction in UTI recurrence rates with generally good tolerance when administered correctly. The drug maintains favor in clinical guidelines due to preserved susceptibility patterns despite decades of use.