Nitrofurantoin

Question 1

Nitrofurantoin - indications

Answer 1

First-line treatment for acute, uncomplicated lower urinary tract infection (UTI) - alternatives are trimethoprim, amoxicillin and cefalexin

Prophylaxis of lower UTI in patients with recurrent infections

Question 2

Nitrofurantoin - MOA

Answer 2

Nitrofurantoin is active against most organisms that cause uncomplicated UTIs including:

• Escherichia coli (gram negative)
• Staphylococcus saprophyticus (gram positive)

Nitrofurantoin is metabolised (reduced) in bacterial cells by nitrofuran reductase = its active metabolite damages bacterial DNA = bacterial cell death

Question 3

Nitrofurantoin - adverse effects (common)

Answer 3

GI upset (nausea +/- diarrhoea)

Immediate and delayed hypersensitivity - rashes, anaphylaxis

Turn urine dark yellow or brown

Question 4

Nitrofurantoin - adverse effect in neonates

Answer 4

Haemolytic anaemia (in neonates)

Question 5

Nitrofurantoin - contraindications (avoid)

Answer 5

• Pregnant women towards term
• Babies in the first 3 months of life
• Patients with renal impairments

Question 6

Long-term use of Nitrofurantoin - cautions

Answer 6

Caution is required when using for long-term prevention of UTIs
Why? Chronic use increases the risk of adverse effects (especially in elderly patients)

Warn patients on long-term treatment to look out for unexplained symptoms such as pins and needles or SOB

Question 7

Why is caution required when using for long-term prevention of UTIs? And what do you need to warn patients about when using long-term?

Answer 7

Why? Chronic use increases the risk of adverse effects (especially in elderly patients)

Warn patients on long-term treatment to look out for unexplained symptoms such as pins and needles or SOB

Question 8

Nitrofurantoin - interactions

Answer 8

NONE