Nitrofurantoin

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	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>

Nitrofurantoin

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
05-22-2009

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*
Macrodantin	Nitrofurantoin macrocrystals	~Procter & Gamble and generic	PO cap 25mg	$1.13
			PO cap 50mg	$0.37
			PO cap 100mg	$0.59
Macrobid	Nitrofurantoin	Proctor & Gamble and generic	PO cap 100mg	$2.36
Furadantin	Nitrofurantoin	Sciele	PO susp 25mg/5mL	$6.63 per 5mL

*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

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.

REFERENCES

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