Know Your Antibiotic: Nitrofurantoin - KASIC

Know Your Antibiotic: Nitrofurantoin

A patient is prescribed nitrofurantoin for an uncomplicated UTI in the ED and sent home. Two days later, the urine culture results with P. mirabilis. Should the antibiotic be changed?

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Best Answer

Yes

Explanation: Nitrofurantoin is a preferred option for the management of UTIs confined to the bladder (i.e. cystitis) because it has high likelihood of activity against the most common urinary pathogen, is well tolerated, and has a low risk for C. difficile infection. Its use can preserve the use of other broader or more toxic alternatives (e.g. fluoroquinolones). It should be avoided in patients with creatinine clearance < 30 mL/min. Notably, some less common pathogens are intrinsically resistant to nitrofurantoin and include Proteus spp., Serratia spp., Morganella spp., Providencia spp., and Pseudomonas spp.

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