CLASSES OF ABX: NITROFURANTOIN Flashcards
MOA
- It is bactericidal in the urinary tract.
Organisms sensitive to the bacterial activity of nitrofurantoin
E. coli, Enterococcus faecalis, Klebsiella species, Enterobacter species, Staphylococcus species.
Spectrum
broad-spectrum antibacterial agent
Active against
Active against the majority of urinary pathogens.
Indications
- Despite being systemically absorbed it is rapidly cleared and only reaches therapeutic concentration in the lower urinary tract.
- Therefore should not be used to treat infections other than lower urinary tract infections.
A specimen of urine should be collected for culture and sensitivity testing before starting antibacterial therapy in:
o Men
o pregnant women
o children < 3 years
o complicated or recurrent infection
o if resistant organisms are suspected.
Side effects
- Pulmonary reactions (acute and chronic)
- Nausea and anorexia
- Hypersensitivity reactions
- Peripheral neuropathy
- Blood disorders.
- May discolour urine yellow or brown
Contraindications and cautions
- Acute porphyrias
- G6PD deficiency.
- eGFR 30-44 (short course)
- Caution in known pulmonary disease
- Avoid at term in pregnancy
Renal impairment
Avoid if eGFR less than 45 mL/ minute/1.73 m2; may be used with caution if eGFR 30–44 mL/ minute/1.73 m2 as a short-course only (3 to 7 days), to treat uncomplicated lower urinary-tract infection
increases toxicity and decreases amount of drug that enters urine, making it less effective.
Pregnancy
Avoid at term in pregnancy
could cause neonatal heamolysis.
Counselling points
Take this medication with or after food
May colour urine yellow or brown (harmless)
Monitoring
- For long-term nitrofurantoin therapy, monitor liver function and monitor for pulmonary symptoms
- Especially in the elderly
- Discontinue if deterioration in lung function.
Interactions - peripheral neuropathy
Amiodarone
Isoniazid
Metronidazole
Phenytoin
PAIM
