nitrofurantoin

(nye troe fyoor an' toyn)

nitrofurantoin
Apo-Nitrofurantoin (CAN), Furadantin, Novo-Furantoin (CAN)

nitrofurantoin macrocrystals
Macrobid, Macrodantin

Pregnancy Category B

Drug classes
Urinary tract anti-infective
Antibacterial

Therapeutic actions
Bacteriostatic in low concentrations, possibly by interfering with bacterial carbohydrate
metabolism; bactericidal in high concentrations, possibly by disrupting bacterial cell wall
formation, causing cell death.

Indications
• Treatment of UTIs caused by susceptible strains of Escherichia coli,
Staphylococcus aureus, Klebsiella, Enterobacter, Proteus
• Prophylaxis or long-term suppression of UTIs

Contraindications and cautions

• Contraindicated with allergy to nitrofurantoin, renal dysfunction; pregnancy,
lactation.
• Use cautiously in patients with G6PD deficiency, anemia, diabetes.

Available forms
Capsules—25, 50, 100 mg; ER capsules—100 mg; oral suspension—25 mg/5 mL

Dosages
ADULTS
50–100 mg PO qid for 10–14 days or 100 mg bid for 7 days (ER capsules). Do not
exceed 400 mg/day.
• Long-term suppressive therapy: 50–100 mg PO at bedtime.
PEDIATRIC PATIENTS
5–7 mg/kg/day in 4 divided doses PO. Not recommended in children < 1 mo.
• Long-term suppressive therapy: As low as 1 mg/kg/day PO in 1 to 2 doses.

Pharmacokinetics
Route Onset Peak
Oral Rapid 30 min
Metabolism: Hepatic; T1/2: 20–60 min
Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Peripheral neuropathy, headache, dizziness, nystagmus, drowsiness, vertigo
• Dermatologic: Exfoliative dermatitis, Stevens-Johnson syndrome, alopecia,
pruritus, urticartia, angioedema
• GI: Nausea, abdominal cramps, vomiting, diarrhea, anorexia, parotitis,
pancreatitis, hepatotoxicity
• Hematologic: Hemolytic anemia in G6PD deficiency; granulocytopenia,
agranulocytosis, leukopenia, thrombocytopenia, eosinophilia, megaloblastic
anemia
• Respiratory: Pulmonary hypersensitivity
• Other: Superinfections of the GU tract; hypotension; muscular aches; brown-rust
urine

Interactions
Drug-drug
• Delayed or decreased absorption with magnesium trisilicate, magaldrate
Drug-lab test
• False elevations of urine glucose, bilirubin, alkaline phosphatase, BUN, urinary
creatinine
• False-positive urine glucose when using Benedict's or Fehling's reagent

Nursing considerations
Assessment
• History: Allergy to nitrofurantoin, renal dysfunction, G6PD deficiency, anemia,
diabetes, pregnancy, lactation
• Physical: Skin color, lesions; orientation, reflexes; R, adventitious sounds; liver
evaluation; CBC; liver and kidney function tests; serum electrolytes; blood, urine
glucose, urinalysis

Interventions
• Arrange for culture and sensitivity tests before and during therapy.
• Give with food or milk to prevent GI upset.
• Continue drug for at least 3 days after a sterile urine specimen is obtained.
• Monitor clinical response; if no improvement is seen or a relapse occurs, send
urine for repeat culture and sensitivity.
• Monitor pulmonary function carefully; reactions can occur within hours or weeks
of nitrofurantoin therapy.
• Arrange for periodic CBC and liver function tests during long-term therapy.

Teaching points
 • Take drug with food or milk. Complete the full course of drug therapy to ensure a
resolution of the infection. Take this drug at regular intervals around the clock;
consult your nurse or pharmacist to set up a convenient schedule.
• These side effects may occur: Nausea, vomiting, abdominal pain (eat frequent
small meals); diarrhea; drowsiness, blurring of vision, dizziness (observe caution
driving or using dangerous equipment); brown or yellow-rust urine (expected
effect).
• Report fever, chills, cough, chest pain, difficulty breathing, rash, numbness or
tingling of the fingers or toes.

Adverse effects in Italic are most common; those in Bold are life-threatening.