“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #24

Lets talk about Macrobid (Nitrofurantoin) for urinary tract infections (UTIs).

I see way to many providers prescribing this to elderly patients for UTIs. You should consider an alternative.

Nitrofurantoin may be ineffective for UTIs in the elderly because age-related declines in renal function result in subtherapeutic concentrations in the urinary tract. Therefore, it does not work as well as other options, such as Bactrim or Cipro.

In addition, nitrofurantoin is identified in the Beers Criteria as a potentially inappropriate medication and should be avoided in individuals 65 years and older due to its potential for pulmonary toxicity, hepatotoxicity and peripheral neuropathy. Also, the Pharmacy Quality Alliance has categorized it as a high risk medication in those older than 65.

Think twice before prescribing nitrofurantoin to elderly patients! There are safer alternatives out there!

4 Responses

  1. In New Jersey we find that cultures are typically resistant to Cipro and Bactrim and leaves little choice for appropriate therapy – especially if allergies to classes of antibiotics are considered on an individual basis. Thoughts?

    Richard Heimbuch APN-BC FNP

    1. Yes, it is an issue. Here is what I suggest: Cefpodoxime or Fosfomycin. I rarely see anyone resistant to those medications and they are safe in the elderly.

  2. Good information. I use caution when prescribing Bactrim due to nephrotoxicity. Bactrim can be hard on patients, especially the elderly.

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