Nitrofurantoin

 

Nitrofurantoin

Trade names: Furadantin, Macrodantin

 

Dosage

v  Adult: PO 50-100mg  qid with meals and HS.

v  Child greater than 1 years of age: PO 1.25-1.75 mg/kg/d divided in 4 doses. Maximum dose 7mg/kg/d

 

What is it

v  Urinary anti-infective- inhibits bacterial enzymes and metabolism

v  Treats many gram-positive and gram-negative rods which include E.coli, Neisseria, streptococci, Staphyloccocus aureus.

v  Treats acute and chronic urinary tract infections

 

Pharmacokinetics

v  Well absorbed through GI tract- should be taken with food to decrease GI upset.

v  Avoid taking antacids at same time as these decrease absorption of drug.

v  Short half life of 20 minutes

v  Excretion occurs in urine as well as small amounts of bile

 

Pharmacodynamics

v  Low doses used for prophylactic use=bacteriostatic effect

v  High doses used for acute infections=bactericidal effect

v  Onset and duration of action is unknown

v  Peak occurs within 30 minutes

 

Assessment

v  Obtain urine culture and sensitivity prior to beginning of antibiotic

v  Assess renal and hepatic function

v  Obtain urine pH, desired is < 5.5 to maximum effectiveness of drug

v  Monitor urine output and specific gravity

v  Monitor for side effects which include anorexia, nausea, discoloration of urine to a brown/rust color, diarrhea, rash, pruritic, dizziness, headache, drowsiness

v  Monitor and assess for adverse reactions which include peripheral neuropathy, super infections (such as stomatitis, genital discharge or itching), hemolytic anemia, agranulocytosis. Life threatening reactions include anaphylaxis, hepatoxicity and Steven Johnson syndrome.

v  Known contraindications: moderate to severe renal impairment, oliguria, anuria, creatine clearance <40ml/min, infants less than 1 year of age, term pregnancy (this drug is a category B), lactation with infant suspected of having G-6-PD deficiencies

v  Known cautions in administration of drug include Vitamin B deficiency, electrolyte imbalances, and diabetes mellitus.

 

Teaching to patient

v  Do not crush or open capsules

v  Drug can stain teeth so should rinse mouth after administration

v  Shake suspension prior to administration

v  Keep at room temperature

v  Patient should not operate motor vehicle or machinery while on medication, as medication can make one drowsy

v  Instruct to report S&S of super infection such as white covering of the tongue, anogenital itching or discharge

v  Should avoid taking drug with antacids and probenecid as this decreases effectiveness of drug.