Names and pronunciation
(nye-troe-fyoor′an-toyn) Furadantin, Macrobid, Macrodantin
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Drug reference
(nye-troe-fyoor′an-toyn) Furadantin, Macrobid, Macrodantin
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Func. class.: Urinary tract antiinfective
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Chem. class.: Synthetic nitrofuran derivative
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ACTION: Inhibits bacterial acetyl-CoA interference with carbohydrate metabolism
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USES: Urinary tract infections caused by Escherichia coli, Klebsiella, Pseudomo- nas, Proteus vulgaris, Proteus morganii, Serratia, Citrobacter, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus, Salmonella, Shigella
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CONTRAINDICATIONS: Infants <1 mo, hypersensitivity, anuria, severe renal disease CCr <60 mL/min, at term pregnancy (38-42 wk), labor, delivery, cholestatic jaundice due to nitrofurantoin therapy Precautions: Pregnancy, breastfeeding, geriatric patients, G6PD deficiency, GI disease, diabetes
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SIDE EFFECTS CNS: Dizziness, headache, drowsiness, peripheral neuropathy, chills, confusion, vertigo, polyneuropathy (high dose) CV: Bundle chest pain GI: Nausea, vomiting, abdominal pain, diarrhea, cholestatic jaundice, loss of appetite, CDAD, hepatitis, pancreatitis HEMA: Anemia, agranulocytosis, hemo- lytic anemia, leukopenia, thrombocy topenia INTEG: Pruritus, rash, urticaria, angio- N edema, alopecia, tooth staining, exfo liative dermatitis, Stevens-Johnson syndrome MS: Arthralgia, myalgia, numbness, peripheral neuropathy RESP: Cough, dyspnea, pneumonitis, pulmonary fibrosis or infiltrate SYST: Superinfection, SLE-like syndrome
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INTERACTIONS Increase: nitrofurantoin toxicity— topical dapsone/tetracaine, prilocaine, sodium nitrate, monitor closely Increase: levels of nitrofurantoin— probenecid, sulfinpyrazone, avoid using together Decrease: absorption of magnesium ant- acid, separate by ≥1 hr Decrease: effect of live virus vaccines, avoid using together Drug/Lab Test Increase: BUN, alk phos, bilirubin, cre- atinine, blood glucose Decrease: WBC, platelets, HB
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DOSAGE AND ROUTES Active UTI • Adult/child >12 yr: PO 50-100 mg qid after meals or 100 mg (Macrobid) q12hr × 7 days • Child 1 mo-12 yr: PO 5-7 mg/kg/day in 4 divided doses UTI prevention • Adult: PO 50-100 mg q PM • Child: PO 1-2 mg/kg/day in PM or 0.5-1 mg/kg q12hr if dose not well tolerated
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Available forms: oral suspension (microcrystals) 25 mg/5 mL; capsules 25, 50, 100 mg macrocrystalline
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Administer: PO route • Give with meals • Do not break, crush, chew, or open tabs, caps, store in original container • Two daily doses if urine output is high or if patient has diabetes • Oral suspension: Shake, use calibrated device to measure liquid product; may mix water, fruit juice; rinse mouth after liquid product; staining of teeth may oc- cur, protect from light
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Assess: • Urinary tract infection: burning, pain on urination; fever; cloudy, foul-smelling urine; I&O ratio: C&S before treatment, after completion; serum creatinine, BUN • Blood count during chronic therapy, LFTs, pulmonary function tests • CDAD: diarrhea with mucus, abdominal pain, fever, fatigue, anorexia; may be treated with vancomycin or metroNIDAZOLE • CNS symptoms: insomnia, vertigo, headache, drowsiness, seizures • Hepatotoxicity: yellowing of skin or eyes, dark urine, clay-colored stools; monitor AST, ALT, stop drug immediately in hepatitis • Pulmonary fibrosis, pneumonitis: dyspnea, tachypnea, persistent cough • Serious skin disorders: fever, flush- ing, rash, urticaria, pruritus • Peripheral neuropathy: paresthesias (more common in diabetes mellitus, electrolyte imbalances, vit B deficiency, debilitated patients) • Beers: avoid in older adults; potential for pulmonary, hepatic toxicity, periph- eral neuropathy • Pregnancy/breastfeeding: do not use in gestation of 38-42 wk or in labor/ delivery; cautious use in breastfeeding, excreted in breast milk
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Evaluate: • Therapeutic response: decreased dys- uria, fever; negative C&S
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To notify prescriber of continued symptoms of UTI, fever, myalgias, arthral- gias, numbness or tingling of extremities • To take as prescribed even if better • To take with food or milk; to avoid al- cohol • To protect susp from freezing; shake well before taking • That product may cause drowsiness; to seek aid with walking, other activities; not to drive or operate machinery while taking medication • That patients with diabetes should monitor blood glucose levels • That product may turn urine rust- yellow to brown • CDAD: to report immediately symptoms of fever; diarrhea with mucus, pus, or blood
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PHARMACOKINETICS PO: Half-life 20-60 min; crosses blood- brain barrier, placenta; enters breast milk; excreted as inactive metabolites in liver, unchanged in urine; protein bind- ing 60%-90%
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• Adult/child >12 yr: PO 50-100 mg qid after meals or 100 mg (Macrobid) q12hr × 7 days
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• Child 1 mo-12 yr: PO 5-7 mg/kg/day in 4 divided doses UTI prevention
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• Child: PO 1-2 mg/kg/day in PM or 0.5-1 mg/kg q12hr if dose not well tolerated
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