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 Guide Editors
 Editor In Chief
    Joel E. Gallant, MD, MPH

Pharmacology Editor
    Paul Pham, PharmD, BCPS

Zambia Guideline Team
   Peter Mwaba MMed PhD FRCP
   Alywn Mwinga MMed
   Isaac Zulu MMed MPH
   Velepie Mtonga MMed
   Albert Mwango MBChB
   Jabbin Mulwanda MMed FCS
 

 

 

Drugs>Antimicrobial Agents>
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Nitrofurantoin

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
10-20-2010

Zambia Specific Information

  • Available formulation in Zambia: Tablet: 100 mg.
  • UTI prophylaxis: nitrofurantoin 100 mg qhs (limit to 6 months).

REFERENCES

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

  • Treatment of uncomplicated urinary tract infection 
NON-FDA APPROVED USES

  • Urinary tract infection, recurrent [women]
  • Urinary tract infections in pregnancy
  • Prophylaxis of UTI

FORMS

brand 
name
 
generic 
Mfg 
brand 
forms
 
cost* 
MacrodantinNitrofurantoin macrocrystals~Procter & Gamble and genericPO
cap
25mg
$1.17
      PO
cap
50mg
$1.54
      PO
cap
100mg
$2.61
MacrobidNitrofurantoinProctor & Gamble and genericPO
cap
100mg
$2.85
FuradantinNitrofurantoinSciele PO
susp
25mg/5mg 470 mg
$38.95

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

 

  • Uncomplicated UTI (in pts with normal renal function): 50-100 mg PO q6h or nitrofurantoin monohydrate/macrocrystals (Macrobid) 100mg PO twice daily.
  • Agent not appropriate for short course (3d) UTI therapy. Dose duration should be 7d minimum.
  • UTI suppression: 50-100mg PO once daily.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose.

DOSING FOR GLOMERULAR FILTRATION OF 10-50

Avoid due to inadequate urinary level and potential for toxic serum level.

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

Avoid due to inadequate urinary level and potential for toxic serum level.

DOSING IN HEMODIALYSIS

Avoid due to inadequate urinary level and potential for toxic serum level.

DOSING IN PERITONEAL DIALYSIS

Avoid due to inadequate urinary level and potential for toxic serum level.

DOSING IN HEMOFILTRATION

Avoid.

ADVERSE DRUG REACTIONS

COMMON

  • GI intolerance (macrocrystalline formulation better tolerated)
OCCASIONAL

  • Hypersensitivity reactions with acute pulmonary symptoms: fever, cough, dyspnea w/ infiltrate and eosinophilia. Occurs within hrs-wks of dose.
  • Lupus-like reaction
  • Rash
RARE

  • Methemoglobinemia and hemolytic anemia (with G6PD deficiency)
  • Hepatitis +/- cholestatic jaundice
  • Peripheral neuropathy
  • Pancreatitis
  • Pulmonary fibrosis with long-term use
  • Lactic acidosis
  • Trigeminal neuralgia
  • Parotitis
  • Hepatitis with cholestasis.

DRUG INTERACTIONS

  • Avoid long term co-administration with drugs associated peripheral neuropathy (e.g. metronidazole, stavudine, didanosine, linezolid). 
  • Norfloxacin: may be antagonistic, avoid concurrent administration.

SPECTRUM

Most E. coli, Citrobacter spp., S. saprophyticus, and E. faecalis. Some Enterobacter spp., Klebsiella spp., and E. faecium.

PHARMACOLOGY

Pharmacology

COMMENTS

Antiseptic for uncomplicated UTI's. Caution when used in G6PD deficient pts. Avoid in pts w/ CrCl < 40 ml/min since efficacy is decreased & side effects increased. Associated with acute allergic pneumonitis w/ short-term treatment; interstitial fibrosis w/ long-term use has been reported. Since resistance remains low, nitrofurantoin is a good alternative to fluoroquinolones in the treatment of uncomplicated UTI. Avoid in patients with a history of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin.

REFERENCES


 
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