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