nitrofurantoin
Table of Contents
nitrofurantoin
introduction
- nitrofurantoin is an antibiotic used in the short term Rx of urinary tract infections (UTIs) / cystitis and is generally regarded as a 4th line antibiotic after trimethoprim, cephalexin, and amoxycillin/clavulanic acid
- it is active against Gram positive and Gram negative urinary tract pathogens, particularly E. coli, but Ps. aeruginosa and some Klebsiella, Aerobacter and Proteus strains are insensitive.
- category A (safe) in pregnancy (except when labour is imminent - see below)
P/K
- only slightly soluble in water but solubility increases in acidic environments
- concurrent antacids may impair absorption
- Macrodantin (nitrofurantoin macrocrystals) is a larger crystal form of Furadantin (nitrofurantoin), and it has slower absorption from GIT and less excretion resulting in less nausea
- urinary levels rise above MIC for ~6hrs
- bacteria develop limited resistance
C/I
- NOT for long term use as risk of peripheral neuropathy and pulmonary toxicity especially in the elderly
- although is safe in pregnancy, it should NOT be used when labour is imminent or to infants under 1 month as risk of neonatal haemolytic anaemia
- anuria or oliguria
- creatinine clearance < 60 mL/minute
- labour
- neonates
- long term use
- hypersensitivity to nitrofurantoin
- does not reach high plasma levels thus may not Rx urosepsis
- will not Rx renal or perinephric abscesses, nor prostatitis
adverse effects
- nausea
- peripheral neuropathy if longer duration Rx
- pulmonary toxicity if longer duration Rx
- hepatitis
- haemolytic anaemia - neonates and patients with G6PD deficiency
- hypersensitivity reactions
dose
- adults:
- 50-100mg qid o (max. 400mg/day)
- children:
- 5 to 7 mg/kg bodyweight per 24 hours to be given in divided doses four times a day
nitrofurantoin.txt · Last modified: 2014/12/15 06:54 by 127.0.0.1