When there is documented nitrofurantoin resistance You can read more about asymptomatic bacteriuria here in the Infectious Diseases Society of America Guideline.Ģ. A positive urine culture is not the same thing as an infection and patients with asymptomatic bacteriuria infrequently require antibiotics. Nitrofurantoin should be avoided if no antibiotics are indicated. It needs to be stated and it always needs to be the first point. When there is no need for treatment or prophylaxis It should be noted that this is not an all-inclusive list and this information is provided to stimulate conversation on the topic, not to replace sound clinical judgment.ġ. So, if nitrofurantoin has such good things going for it, then an important question you may ask is: when should I avoid nitrofurantoin? Here I provide some of the times when you should consider avoiding nitrofurantoin. Such data further supports the use of nitrofurantoin as a preferred oral agent in uncomplicated cystitis. coli isolates they found a decrease in fluoroquinolone use, decrease in fluoroquinolone resistance, and no change in nitrofurantoin resistance. In their retrospective pre-intervention (2003-2007) / post-intervention (2007-2012) study including over 11,000 E. Combine this information with the fact that the FDA has released additional boxed warnings on fluoroquinolone and recommendations against their use of for uncomplicated cystitis, and many organizations are looking to use nitrofurantoin over fluoroquinolones whenever possible.Įxperience with placing nitrofurantoin as the preferred agent over fluoroquinolones for acute uncomplicated cystitis was recently published in an article by Peddle and colleagues in April 2017. Antipseudomonal penicillin/beta-lactamase inhibitor: Sulfamethoxazole-trimethoprim: ~30% resistant.Ampicillin/beta-lactamase inhibitor: 40% resistant. ![]() They found the following prevalence of resistance: One of the largest recent data sets comes from Morrill and colleagues in their 2017 study investigating over 300,000 Escherichia coli urinary isolates collected between 20 from 127 Veterans Affairs facilities. ![]() coli from urinary isolates show favorable results for nitrofurantoin as compared to other commonly used agents. Numerous studies investigating antimicrobial susceptibilities of E. coli while drugs like SMX-TMP and ciprofloxacin are getting worse, but when should you avoid nitrofurantoin? This article discusses the topic.Īuthored By: Timothy P. It is retaining activity against the uropathogen E.
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