Is Macrobid Safe in 1st Trimester Pregnancy?

The ACOG committee opinion recommending withholding nitrofurantoin unless alternative agents are unavailable should be revisited. Emergency physicians should have a low threshold to prescribe nitrofurantoin for patients with urinary tract infections in the first trimester of pregnancy, particularly when there is suspicion for cephalosporin-resistant organisms—that is, patients with recent antibiotic use, previous resistant organisms, or nitrite-negative urinalyses.

 Spotlight on nitrofurantoin

Nitrofurantoin is contraindicated in patients with an eGFR less than 60 mL/minute/1.73 m2 due to the increased risk of toxicity and decreased efficacy.

The Clinical Efficacy of Nitrofurantoin for Treating Uncomplicated Urinary Tract Infection in Adults: A Systematic Review of Randomized Control Trials

Although no firm conclusions can be made on the current base of evidence, the studies generally suggest that nitrofurantoin is at least comparable to other common uUTI treatments in terms of clinical and bacteriological cure.

Macrobid For UTI Treatment: Pros And Cons

Concerns with long-term use - Although relatively rare, nitrofurantoin is one of the commonest causes of drug-induced pulmonary disease, which can be very serious and even life-threatening.

MY APPROACH to UTIs in Women

We recommend the most inexpensive narrow-spectrum antibiotic; nitrofurantoin is my favorite. It’s been around for 40 or 50 years. There hasn’t been a lot of resistance developing to it at all. It concentrates in the urine; the half-life in the blood is only 20 minutes. Patients tend not to get vaginal yeast infections from it, and it remains very effective. Other antibiotics that are okay are trimethoprim or trimethoprim/sulfamethoxazole for first-time infections. There is a lot of resistance to ampicillin and amoxicillin, so we don’t generally use the penicillins.

Nitrofurantoin and Sulfamethoxazole-Trimethoprim: Are they Safe during Pregnancy?

Controversy still exists regarding the safety of both SMZ-TMP and nitrofurantoin during pregnancy.

Nitrofurantoin is as effective as other long-term antibiotics for preventing recurrent urinary tract infections

The antibiotic nitrofurantoin works as well as other long-term antibiotics for preventing recurrent urinary tract infections in women. However gastrointestinal side effects were more common in people on nitrofurantoin. The potential for inducing less antibiotic resistance compared to trimethoprim is a potential advantage of nitrofurantoin but this wasn’t a specified outcome for this review.

Nitrofurantoin Pharmacology

Nitrofurantoin works by damaging bacterial DNA. In bacterial cells, nitrofurantoin is reduced by nitrofuran reductase. The resulting metabolite is highly reactive and attacks ribosomal proteins, DNA and pyruvate metabolism. It is not yet known which specific action is responsible for its bactericidal activity.

Nitrofurantoin-induced liver failure

Most clinicians are familiar with the risk of peripheral neuropathy and pulmonary toxicity as adverse effects of nitrofurantoin; however, hepatotoxicity, which might present after acute or chronic use and which can be fatal, might be overlooked.

Role of Nitrofurantoin in the Management of Urinary Tract Infection - A Systematic Review

Nitrofurantoin exhibits high quality success against most bacteria anticipated in urinary tract infection. Nitrofurantoin has been recommended for prophylaxis in the treatment of reinfection in case of recurrent uncomplicated urinary tract infections in many western countries. Nitrofurantoin is one of the treatment options for urinary tract infection due to extended spectrum beta lactamase producing Escherichia coli. In pregnant women with urinary tract infection, nitrofurantoin can be appropriate treatment. Also, nitrofurantoin associated reactions have been reported in many studies.

Short-Course Nitrofurantoin for the Treatment of Acute Uncomplicated Cystitis in Women

A 5-day course of nitrofurantoin is equivalent clinically and microbiologically to a 3-day course of trimethoprim-sulfamethoxazole and should be considered an effective fluoroquinolone-sparing alternative for the treatment of acute cystitis in women.

Support for nitrofurantoin in uncomplicated urinary tract infections

Despite of slight differences between countries, nitrofurantoin, pivmecillinam, fosfomycin, trimethoprim or trimethoprim/sulfamethoxazole are the most recommended first-line antibiotics. These drugs have been introduced in the market for more than three decades and are still well established.

Treatment options for urinary tract infections | Understanding UTIs, Part 5

Health care providers usually pick from one of three antibiotics for uncomplicated UTIs (UTIs in the lower urinary tract of non-pregnant, premenopausal women). Nitrofurantoin (brand name Macrobid): This drug is used in 32% of UTIs in the United States. Trimethoprim-sulfamethoxazole (Bactrim): This combination of two drugs is used in 26% of UTIs in the United States. Fosfomycin (Monurol): This newer drug only has to be taken one time, but it's expensive and rarely prescribed.

Why Nitrofurantoin for Cystitis? The burning question!

We have changed to Nitrofurantoin(brand name Macrobid) as first line treatment for women with lower urinary tract infection (also called cystitis} due to the NICE (National Institute for Clinical Excellence) guidelines for women who do not have a catheter. It aims to optimise antibiotic use and reduce antibiotic resistance.