Nitrofurantoin

A to Z Drug Facts

(nye-troe-FYOOR-an-toyn)

Furadantin, Macrobid, Macrodantin,  Apo-Nitrofurantoin, Novo-Furantoin

Class: Urinary anti-infective

 Action May interfere with bacterial cell wall formation and bacterial duplication. Inhibits bacterial carbohydrate metabolism. Bacteriostatic in low concentrations; bactericidal at higher concentrations.

 Indications Treatment of urinary tract infections caused by susceptible strains of E. coli, enterococci, Staphylococcus aureus, certain strains of Klebsiella, Enterobacter and Proteus species.

 Contraindications Renal impairment (creatinine clearance < 40 mL/min); anuria or oliguria; pregnant women at term; infants < 1 mo.

 Route/Dosage

ADULTS & CHILDREN > 12 YR: PO 50 to 100 mg qid with meals for minimum of 7 days and for at least 3 days after sterile urine is obtained. CHILDREN > 1 MO: PO 5 to 7 mg/kg/24 hr in 4 divided doses with meals and at bedtime for minimum of 7 days and for at least 3 days after sterile urine is obtained.

Long-Term Suppressive Therapy

ADULTS: PO 50 to 100 mg at bedtime. CHILDREN: PO 1 mg/kg/24 hr as single or 2 divided doses.

 Interactions

Anticholinergic drugs and food: Increased absorption of nitrofurantoin. Magnesium salts: May reduce anti-infective action by decreasing absorption. Probenecid: May increase nitrofurantoin serum levels by reducing renal elimination.

 Lab Test Interferences Urinary creatinine elevation and false-positive urine glucose determination with Benedict's reagent (copper sulfate solution) may occur.

 Adverse Reactions

CNS: Peripheral neuropathy; headache; dizziness; nystagmus; drowsiness. DERM: Exfoliative dermatitis; erythema multiforme; maculopapular, erythematous or eczematous eruption; pruritus; urticaria; angioedema; alopecia; photosensitivity. GI: Anorexia; nausea; emesis; abdominal pain; diarrhea; parotiditis; pancreatitis. GU: Superinfection. HEPA: Hepatitis; hepatotoxicity; jaundice; increased bilirubin and alkaline phosphatase; permanent liver dysfunction. HEMA: Hemolytic anemia from G-6-PD deficiency; granulocytopenia; agranulocytosis; leukopenia; thrombocytopenia; eosinophilia; megaloblastic anemia; aplastic anemia. RESP: Acute, subacute or chronic pulmonary reaction (eg, shortness of breath, chest pain, cough, fever, chills); permanent pulmonary impairment. OTHER: Anaphylaxis; asthmatic attack in patient with history of asthma; drug fever; arthralgia; sialadenitis; muscular aches.

 Precautions

Pregnancy: Category B. Contraindicated in women at term. Do not give to pregnant patient with G-6-PD deficiency. Lactation: Excreted in breast milk. Children: Contraindicated in infants < 1 mo. Hemolysis: Hemolytic anemia has occurred, apparently linked to G-6-PD deficiencies. Discontinue at any sign of hemolysis. Peripheral neuropathy: May become severe or irreversible; fatalities have been reported. Predisposing conditions such as renal impairment, anemia, diabetes, electrolyte imbalance, vitamin B deficiency and debilitating diseases may increase risk. Pulmonary reactions: Acute and chronic reactions, including interstitial pneumonia, respiratory failure and death, have occurred. Do not give to any patient who has had pulmonary reaction to drug. Superinfection: Prolonged or repeated therapy with antibiotics may result in overgrowth of nonsusceptible bacteria or fungi.

 Administration/Storage

• Administer with food or milk.
• Oral suspension can be mixed with water, juice, or formula.
• Have patient rinse mouth after administration to avoid staining teeth.
• Have patient swallow tablets or capsules whole. Instruct patient not to open capsule or crush tablets.
• Nitrofurantoin and nitrofurantoin macrocrystalline are not interchangeable because of differences in absorption. Macrobid brand is formulated for every 12-hr administration.
• Store at room temperature in tightly closed container. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Obtain urine for culture and sensitivity prior to starting drug.
• Obtain results of CBC and other lab tests ordered by physician (ie, creatinine, electrolytes, alkaline phosphatase, bilirubin).
• Obtain vital signs. Monitor weight and I&O.
• Evaluate for signs of infection (ie, fever, chills, drainage, burning, frequency or hesitancy).
• Evaluate for dizziness, headaches, GI upset, skin changes, hearing, or vision changes.
• If patient exhibits shortness of breath, chest pain, continued fever, numbness, tingling, headache, dizziness, drowsiness, nystagmus, blood in urine, or signs of hemolysis, notify physician.

 Patient/Family Education

• Remind patient to shake nitrofurantoin suspension before measuring dose.
• Instruct patient to take medication with food or milk.
• Inform patient to expect urine to be orange or brown in color while taking medication.
• Teach patient importance of completing full course of antibiotic to avoid recurrent infection.
• Instruct patient to report the following symptoms to physician: Shortness of breath, difficulty breathing, changes in urination (other than orange discoloration), nausea, vomiting, diarrhea, cramping, skin changes, chest pain, cough, fever, headache, dizziness, vision changes, unusual bleeding (ie, red or black urine or stool), yellowing of skin, light-colored stools or edema.
• Caution patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts