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.


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.


Human Data Suggest Risk in the 3rd Trimester


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.


20-60 minutes