Nitrofurantoin

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Inhibits bacterial enzyme systems thus interferes with metabolism and cell wall synthesis.

Indications and Clinical Use:

For the treatment of urinary tract infections caused by susceptible gram-negative and some gram-positive organisms; Escherichia coli, Staphylococcus aureus, Enterococcus, Klebsiella, and Enterobacter.

Contraindications:

Contraindicated, at term (37 or more weeks), or when onset of labour is imminent as it may cause hemolytic anemia in infants, most often in the Mediterranean population.

Warnings and Precautions:

Caution is advised with G6PD deficiency or anemia. Although rare, severe hepatic reactions have been associated with nitrofurantoin (onset may be insidious); discontinue immediately if hepatitis occurs. Has been associated with peripheral neuropathy (rare); risk may be increased by renal impairment, diabetes, vitamin B deficiency, or electrolyte imbalance.

Pregnancy:

Human Data Suggest Risk in the 3rd Trimester

Lactation:

Category L2 – Limited Human Data – Probably Compatible
Use with caution in newborns at risk for hyperbilirubinemia.

Adverse Reactions:

Nausea, vomiting, diarrhea, drowsiness and dizziness, peripheral neuropathy (reversible) and respiratory symptoms (drug-induced pneumonitis).

Dosage and Administration:

Asymptomatic Bacteriuria: Regular release (Macrodantin®) 50-100mg PO with food q6 hours (QID) for 3 days

Cystitis: Sustained release (Macrobid®) 100mg PO q12 hours (BID) for 5 days OR
Regular release (Macrodantin®) 50-100mg PO q6 hours (QID) for 5 days
Take with meals to improve absorption and decrease adverse effects.

Onset of Action:

Metabolized according to sustained or regular release. Slower absorption in sustained release.

Peak Antibacterial Concentrations:

approximately 30 minutes.

Half-life:

20-60 minutes