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Nitrofurantoin is bactericidal; the exact mechanism is unknown.
Pharmacology:
Nitrofurantoin is available only as an oral preparation. It is absorbed well and excreted in urine. Adverse effects limit doses so therapeutic levels are achieved only in the urine.
Indications:
It is used only for the treatment or prophylaxis of uncomplicated UTI. In women with recurrent UTIs, it may decrease the number of episodes. It is active against common uropathogens, such as Escherichia coli
, Staphylococcus saprophyticus
, and Enterococcus faecalis. E. faecium, including vancomycin -resistant strains, Klebsiella, and Enterobacter sp are less susceptible. Most strains of Proteus
, Providencia
, Morganella
, Serratia
, Acinetobacter
, and Pseudomonas are resistant. There is no cross-resistance with other antibiotic classes.
Toxicity:
Nitrofurantoin is contraindicated in renal insufficiency. Common adverse reactions are nausea and vomiting, which are less likely with the macrocrystalline form. Fever, rash, hypersensitivity pneumonitis, and progressive pulmonary interstitial fibrosis may occur. Paresthesias may result and may be followed by a severe ascending motor and sensory polyneuropathy if the drug is continued, especially in patients with renal failure. Leukopenia and hepatotoxicity have been reported, and hemolytic anemia can occur in patients with G6PD deficiency.
Last full review/revision November 2005
Content last modified November 2005
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