Nitrofurantoin

C. diff Risk

Low

Oral Bioavailability

Moderate

Approximate Cost

$1/day

Dosing

Adult

50-100 mg PO q6h
100 mg PO q12h (MacroBID® formulation)

Neonatal

Contraindicated in infants < 1 month of age.

Renal

Use is contraindicated in CrCl< 40-60 mL/min. Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing

General Information

Common Usage

Uncomplicated cystitis in patients with normal renal function.
Does not provide adequate renal concentrations for treatment of systemic infections (i.e urosepsis, pyelonephritis); appropriate for cystitis and/or urinary prophylaxis.

Drug Monitoring

Monitor liver and renal function and pulmonary function (with long term use). CBC for hemolytic anemia.

Adverse Effects

Nausea (decreased if taken with food)
Hemolytic anemia if G6PD-deficient
Peripheral neuropathy
Interstitial pneumonitis and fibrosis with prolonged use (> 6 months)

Additional Information

Does not provide adequate renal concentrations for treatment of systemic infections (i.e urosepsis, pyelonephritis); appropriate for cystitis and/or urinary prophylaxis.

Reduce dose in renal impairment or need for caution.
Contraindicated in infants less than 1 month of age (risk of hemolytic anemia), moderate-severe renal impairment, G-6-PD deficiency.
Do not use near term in pregnancy.

Pharmacology

Antimicrobial class: Nitrofuran

Route of Elimination: As metabolites and unchanged drug (40%) in the urine and small amounts in the bile; renal excretion is via glomerular filtration and tubular secretion

Average serum half life: No pediatric data.
Adults: 20 to 60 minutes and is prolonged with renal impairment