View source for Nitrofurantoin

==General==
*Type: [[Antibiotic]]
*Dosage Forms: oral 
*Common Trade Names: Macrobid

==Adult Dosing==
===Cystitis, acute uncomplicated or acute simple:<ref>Nitrofurantoin: Drug information. UpToDate. www.uptodate.com. Accessed April 1, 2019.</ref>===
*Monohydrate/macrocrystals (Macrobid): 100mg PO q12h
*Macrocrystals: 50-100mg PO 4 times daily for 5 days

===Cystitis, recurrent, prophylaxis (continuous):<ref>Nitrofurantoin: Drug information. UpToDate. www.uptodate.com. Accessed April 1, 2019.</ref>===
*Monohydrate/macrocrystals (Macrobid): 100mg PO daily at bedtime
*Macrocrystals: 50-100mg PO daily at bedtime 

===Cystitis, postcoital prophylaxis===
*Monohydrate/macrocrystals (Macrobid): 100mg PO once within 2 hours of sexual intercourse
*Macrocrystals: 50-100mg PO once within 2 hours of sexual intercourse

==Pediatric Dosing==
*>12yo: same as adult dosing

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B
*Lactation Risk: Infant risk minimal
*Renal Dosing: Contraindicated if CrCl <60
*Hepatic dosing: 

==Contraindications==
*Allergy to class/drug
*Neonates, pregnant women at term or when delivery imminent
*Renal failure due to accumulation of metabolites that may cause peripheral neuropathy<ref>Spring PJ, Sharpe DM, Hayes MW. Nitrofurantoin and peripheral neuropathy: A forgotten problem? Med J Aust 2001;174:153-4.</ref>
*CrCL < 60, oliguria, anuria
*Cholestatic jaundice history

==Adverse Reactions==
===Serious===
*[[Hemolytic anemia]] can occur in patients with G6PD deficiency and in infants less than 1 month old
*Hepatic necrosis
*[[Hepatitis]]
*Cholestatic jaundice syndrome
*Erythema multiforme/SJS
*[[Pancreatitis]]
*Peripheral [[neuropathy]]
*Pulmonary hypersensitivity
*[[Agranulocytosis]]
*[[Leukopenia]]
*[[Thrombocytopenia]]
*[[Pneumonitis]]
*Pulmonary fibrosis
*Cyanosis
*ECG abnormality
*C. difficle associated [[diarrhea]]
*Optic neuritis
*Pseudotumor cerebri
*Psychosis
*[[Vasculitis]]
===Common===
*[[Nausea]]
*[[Headache]]
*Anorexia
*[[Abdominal pain]]
*[[Diarrhea]]
*Flatulence
*Asthenia
*[[Vertigo]]
*[[Nystagmus]]
*[[Dizziness]]
*Confusion
*Depression
*Alopecia
*Yellow/brown urine
*Sialadenitis
*[[Fever]]
*[[Pruritus]]
*Urticaria
*Arthralgia
*Myalgia
*Rigors

==Pharmacology==
*Half-life: 45-60min
*Metabolism: Hepatic
*Excretion: Urine primarily (30-40% unchanged); Bile
*Mechanism of Action: Inactivates bacterial ribosomal proteins

==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||X1
|-
| ||Strep. anginosus gp||X1
|-
| ||[[Enterococcus faecalis]]||'''S'''
|-
| ||[[Enterococcus faecium]]||'''S'''
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||'''S'''
|-
| ||[[CA-MRSA]]||'''S'''
|-
| ||[[Staph. Epidermidis]]||X1
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||X1
|-
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
|-
| ||[[N. meningitidis]]||X1
|-
| ||[[Moraxella catarrhalis]]||X1
|-
| ||[[H. influenzae]]||X1
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||I
|-
| ||E. coli/Klebsiella ESBL+||X1
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||I
|-
| ||[[Enterobacter]] sp, AmpC pos||I
|-
| ||[[Serratia]] sp||X1
|-
| ||Serratia marcescens||R
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||X1
|-
| ||[[Proteus vulgaris]]||R
|-
| ||[[Providencia sp.]]||X1
|-
| ||[[Morganella sp.]]||X1
|-
| ||[[Citrobacter freundii]]||X1
|-
| ||[[Citrobacter diversus]]||X1
|-
| ||[[Citrobacter sp.]]||X1
|-
| ||[[Aeromonas sp]]||X1
|-
| ||[[Acinetobacter sp.]]||X1
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||X1
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||X1
|-
| ||[[Pasteurella multocida]]||X1
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||R
|-
| ||[[Mycoplasm pneumoniae]]||X1
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||X1
|-
| Anaerobes||[[Actinomyces]]||X1
|-
| ||[[Bacteroides fragilis]]||X1
|-
| ||[[Prevotella melaninogenica]]||X1
|-
| ||[[Clostridium difficile]]||X1
|-
| ||[[Clostridium (not difficile)]]||X1
|-
| ||[[Fusobacterium necrophorum]]||X1
|-
| ||[[Peptostreptococcus sp.]]||X1
|}

===Key===
{{Template:Antibacterial Spectra Key}}

==See Also==

==References==
<references/>

[[Category:Pharmacology]]
[[Category:ID]]