nitrofurantoin and renal impairment

Last edited 05/2023 and last reviewed 08/2023

Nitrofurantoin and renal impairment

Nitrofurantoin is an oral antibiotic for the treatment and prevention of urinary tract infections (1)

• antibacterial efficacy in this infection depends on the renal secretion of nitrofurantoin into the urinary tract
• with renal impairment, renal secretion of nitrofurantoin is reduced
  • may reduce the antibacterial efficacy, increase the risk of side effects (eg, nausea, vomiting, loss of appetite), and may result in treatment failures
  • Geerts et al noted that:
    • nitrofurantoin treatment was not associated with a higher risk of ineffectiveness in women with UTI and moderate renal impairment (30-50 ml/min/1.73 m^2)
    • did find a significant association between renal impairment (<50 ml/min/1.73 m^2) and pulmonary adverse events leading to hospitalization

Advice for healthcare professionals (1)

• nitrofurantoin is contraindicated in patients with an estimated glomerular filtration rate (eGFR) of less than 45 ml/min/1.73m2
  
  
• nitrofurantoin should not be used to treat sepsis syndrome secondary to urinary tract infection or suspected upper urinary tract infections
  
  
• a short course (3 to 7 days) may be used with caution in certain patients with an eGFR of 30 to 44 ml/min/1.73m2
  • only prescribe to such patients to treat lower urinary tract infection with suspected or proven multidrug resistant pathogens when the benefits of nitrofurantoin are considered to outweigh the risks of side effects
    
    
• consider checking renal function when choosing to treat with nitrofurantoin, especially in the elderly
  
  
• closely monitor for signs of pulmonary, hepatic, neurological, haematological, and gastrointestinal side effects during treatment, as previously advised in the summary of product characteristics (see below)
  
  
• consult official guidance on the appropriate use of antibiotics when prescribing nitrofurantoin

Reference:

• Drug Safety Update volume 8 issue 2, September 2014: A3
• Geerts AF, Eppenga WL, Heerdink R, Derijks HJ, Wensing MJ, Egberts TC, De Smet PA. Ineffectiveness and adverse events of nitrofurantoin in women with urinary tract infection and renal impairment in primary care. Eur J Clin Pharmacol. 2013 Sep;69(9):1701-7.