Nitrofurantoin Flashcards

1
Q

What part of a bacterial cell does nitrofurantoin target?

A

DNA

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2
Q

How does nitrofurantoin work?

A

Bacterial cells have nitrofurantoin reductase.
Nitrofuran reductase metabolises (reduces) nitrofuranotin –> an active DNA damaging metabolite
This active DNA damaging metabolite causes cell death making it BACTERIOCIDAL

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3
Q

Is nitrofurantoin bacteriostatic or bactericidal?

A

Batceriocidal

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4
Q

What bacteria does nitrofurantoin work against?

A
Gram positive (Staphylococuss saprophytious) and Gran negative (e.coli) 
These are common causes of UTI
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5
Q

How do bacteria become resistant to nitrofurantoin?

A

Some bacteria have reduced levels of nitrofuran reductase - RARE IN ECOLI
Some bacteria have intrinsic resistance e.g. kelbsiella and proteus - these are less common causes of UTI

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6
Q

What bacteria have intrinsic resistance to nitrofurantoin?

A

Kelbsiella and proteus

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7
Q

What are the common uses of nitrofurantoin?

A
  1. UTI

- first line for UTI (trimethoprim and amoxicillin otherwise)

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8
Q

What makes nitrofurantoin good for use against UTIs?

A

Good as bactericidal
Had most bactericidal effect in acidic environments e.g. UTI
Reaches high concentrations in urine

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9
Q

What are the contra-indications for using nitrofurantoin?

A
  1. Pregnant
  2. Babies in first three months
  3. Renal Impairment (impaired excretion increases toxicity and reduces efficacy)
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10
Q

What are the cautions when using nitrofurantoin?

A

Long term prevention of UTI

- chronic use increases risk of adverse effects especially in the elderly

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11
Q

What are the interactions with nitrofurantoin?

A

No significant interactions

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12
Q

What are the common side effects of nitrofurantoin?

A
  1. GI Upset (nausea and diarrhoea)
  2. Hypersensitivity reactions (immediate and delayed)
  3. Turns urine dark yellow/brown
  4. Less commonly
    - Chronic pulmonary reactions (pneumonitis fibrosis)
    - Hepatits
    - Peripheral neuropathy
    - In neonates: haemolytic anemia (ask immature RBCS cant mop up nitrofurantoin superoxides)
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13
Q

What form is nitrofurantoin available in?

A

Oral administrations

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14
Q

How long should nitrofurantoin be prescribed for?

A

3 days in women with uncomplicated UTI

7 day course in men or more complicated

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15
Q

Should you use nitrofurantoin for pyelonephritis?

A

No
Use co-amoxiclav with gentamicin
Or ciprafloxacin

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