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 prevention and treatment of urinary tract infections caused by susceptible gram-negative and some gram-positive organisms; E. coli, S. aureus, Enterococcus, Klebsiella, and Enterobacter. Pseudomonas, Serratia, and most species of Proteus are generally resistant to nitrofurantoin.
Contraindicated, at term (37-42 weeks), during labour, 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.
Nausea, vomiting, diarrhea, drowsiness and dizziness, peripheral neuropathy (reversible) and respiratory symptoms (drug-induced pneumonitis).
Dosage and Administration:
Sustained release (commonly Macrobid®): 100 mg orally with food every 12 hours (bid) for 5 to 7 days, or
Regular release – 50-100 mg orally with food every 6 hours (qid) for 3 days if UTI is asymptomatic and 7 days if symptomatic.
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.