Antimicrobials

Active against: most common uropathogens

• Gram positives: S. saprophyticus, Enterococcus species (E. faecalis, E. faecium – including some strains of vancomycin resistant Enterococci (VRE))
• Gram negatives: coli, Klebsiella species (including extended spectrum beta-lactamase (ESBL) producing strains), Citrobacter species, Enterobacter species

Not active against:

• Proteus species
• Pseudomonas aeruginosa
• Serratia marcescens

• Treatment of lower urinary tract infections (cystitis) caused by susceptible organisms

• Treatment of upper urinary tract infections (e.g. pyelonephritis, renal/perinephric abscess, prostatitis)
• Treatment of any systemic infection
• Pregnancy and breastfeeding - for safety information, see Table on Safety of Anti-infective therapy in Pregnancy & Lactation

• GI intolerance (common)
• Rash (common)
• Headache (common)
• Hypersensitivity reaction – with acute pulmonary symptoms (fever, cough, dyspnea, pulmonary infiltrates)
• Pulmonary toxicity (uncommon; higher risk in the elderly, with reduced renal function and chronic use)
• Pulmonary fibrosis (uncommon; higher risk with chronic use > 6 months)
• Peripheral neuropathy (uncommon)
• Hepatitis (uncommon)

Usual Dosage:

• MacroBID®100 mg capsule: 100 mg PO BID
• OR Nitrofurantoin 50 mg tablet (for enteral feeding or crushing): 50 mg PO QID
  • *Note: MacroBID®100 mg capsule is the preferred product for use in most situations; however, the capsules should not be opened. For patients requiring administration via enteral feeding tube or for those who cannot swallow capsules, nitrofurantoin 50 mg tablets should be used instead

Renal Insufficiency: do not use in patients with CrCl < 40 mL/min or in patients on renal replacement therapy due to concerns of decreased efficacy and increased risk of toxicity