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Abstract:
For more than 30 years nitrofurantoin has been a widely prescribed and effective agent in the treatment of urinary tract infections. During this time, it has withstood the rigors of constant clinical evaluation and has competed successfully with more recent antibacterial agents. As with many widely used drugs, some serious and potentially hazardous reactions to therapy have been documented. This article reviews and analyzes major reported reactions and interactions from both published and unpublished sources. Incidence rates have been calculated for pulmonary, hepatic, neurological, and hematological responses. Calculated rates of occurrence were very low, and ranged from 0.001 percent of courses of therapy (all types of pulmonary reactions combined) to 0.0007 percent (neurological reactions). Reports on interactions of nitrofurantoin with alcohol, antacids, and oral contraceptives are unfounded and anecdotal. Interactions with nalidixic and oxolinic acids are not clinically significant, and only one case of interaction has been reported with phenytoin. Bioavailability is enhanced by food or propantheline. False positives occur with Benedict's test for urine glucose estimations.
Insights
Nitrofurantoin remains a highly effective antibiotic for urinary tract infections, with serious adverse reactions occurring at very low rates. Documented interactions are rare and generally not clinically significant.
Area of Science:
- Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Nitrofurantoin has been a cornerstone treatment for urinary tract infections (UTIs) for over three decades.
- It has consistently demonstrated efficacy against common UTI pathogens.
- Despite its long-standing use, a comprehensive review of its safety profile and drug interactions is warranted.
Purpose of the Study:
- To review and analyze reported adverse reactions and drug interactions associated with nitrofurantoin therapy.
- To calculate incidence rates for specific adverse events.
- To evaluate the clinical significance of reported drug interactions.
Main Methods:
- Systematic review of published and unpublished data on nitrofurantoin.
- Calculation of incidence rates for pulmonary, hepatic, neurological, and hematological reactions.
- Analysis of reported interactions with other medications and substances.
Main Results:
- Serious adverse reactions to nitrofurantoin occur at very low incidence rates, ranging from 0.0007% (neurological) to 0.001% (pulmonary).
- Reported interactions with alcohol, antacids, and oral contraceptives are unsubstantiated.
- Interactions with nalidixic acid and oxolinic acid are not clinically significant; only one interaction with phenytoin was reported.
Conclusions:
- Nitrofurantoin possesses a favorable safety profile with a low incidence of serious adverse events.
- Most reported drug interactions are either unfounded, anecdotal, or clinically insignificant.
- Nitrofurantoin remains a safe and effective option for treating urinary tract infections.