Usage of nitrofurantoin

The use of nitrofurantoin is now recommended in numerous guidelines worldwide.

IDSA, ESCMID

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

UTI guideline IDSA ESCMID

“Nitrofurantoin monohydrate/macrocrystals (100 mg twice daily for 5 days) is an appropriate choice for therapy due to minimal resistance and propensity for collateral damage and efficacy comparable to 3 days of trimethoprim-sulfamethoxazole.”

“Despite wide variability in antimicrobial susceptibility among the different countries studied, nitrofurantoin, fosfomycin, and mecillinam had good in vitro activity in all the countries investigated. Thus, these 3 antimicrobials could be considered appropriate antimicrobials for empirical therapy in most regions.”

European Association of Urology

Recommended antimicrobial therapy in acute uncomplicated cystitis in otherwise healthy premenopausal women according to the guidelines of the European Association of Urology:

Antibiotics Daily dose Duration of therapy
Fosfomycin trometamol 3 g SD 1 day
Nitrofurantoin 50 mg q6h 7 days
Nitrofurantoin macrocrystal 100 mg bid 5-7 days
Pivmecillinam* 400 mg bid 3 days
Pivmecillinam* 200 mg bid 7 days

* available only in Scandinavia, the Netherlands, Austria, and Canada

Nitrofurantoin is also listed as option for prophylaxis in recurrent (uncomplicated) UTIs in women:

Nitrofurantoin 50 mg or 100 mg once (daily) as continuous or postcoital antimicrobial prophylaxis

German association of medical societies

The guideline recommends nitrofurantoin as a first line agent for the therapy of uncomplicated cystitis in women (retard form 100mg twice daily for 5 days

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