Nitrofurantoin

Question 1

what is nitrofurantoin commonly indicated for?

Answer 1

1) first line for acute lower UTI (Trimethoprim, amoxicillin and Cefalexin are alternatives)
2) Prophylaxis of UTI in recurrent infections

Question 2

what is the spectrum of activity of nitrofurantoin?

Answer 2

1) escherichia coli

2) staphylococcus saprophyticus

Question 3

what is the MoA of nitrofurantoin?

Answer 3

Bactericidal- damages bacterial DNA and causes cell death

Question 4

list some of the common adverse effects caused by nitrofurantoin?

Answer 4

1) GI upset- nausea
2) blood disorders
3) Pulmonary reactions
4) hepatitis and peripheral neuropathy with long term use
5) haemolytic anaemia in neonates

Question 5

who should nitrofurantoin be avoided in?

Answer 5

1) pregnant women at term
2) Babies in the first 3 months of life ( C/IG6PD- infants)
3) C/I in renal impairment- AVOID if eGFR < 45ml/min
4) Chronic use can increase adverse effects, esp in elderly

Question 6

outline the monitoring requirements for nitrofurantoin

Answer 6

1) Hepatic function

2) Pulmonary function- discontinue if deterioration in lung function

Question 7

what patient and carer advice should be provided to those taking nitrofurantoin?

Answer 7

1) Take with or after food to prevent GI upset
2) Discolours urine- dark yellow or brown
3) report pins and needles and breathlessness