It is generally accepted that nitrofurantoin may be ineffective for UTIs in the elderly because age-related declines in renal function result in subtherapeutic concentrations in the urinary tract. However, the recommendation to avoid the drug in the elderly is not because it causes nephrotoxicity.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nitrofurantoin in the elderly. However, elderly patients are more likely to have age-related heart, liver, lung, or kidney problems, which may require caution in patients receiving nitrofurantoin.
That means nitrofurantoin can steadily accumulate in the body, which may cause serious side effects, including: anxiety attacks, delusions and hallucinations.
Chronic administration of nitrofurantoin has been associated with the potential for development of pulmonary toxicity. In addition, diminished renal function can lead to inadequate concentration of the medication in urine.
Patients with anuria, oliguria, or significant impairment of renal function (defined as creatinine clearance [CrCl] of less than 60 mL/min or clinically significant raised serum creatinine) should not take nitrofurantoin.
Nitrofurantoin is known to be substantially excreted by the kidney. Anuria, oliguria, or significant impairment of renal function, defined as a creatinine clearance (CrCl) less than 60 mL/minute or clinically significant elevated serum creatinine, are contraindications to nitrofurantoin use per the package labels.
Many people using this medication do not have serious side effects. This medication may rarely cause very serious (possibly fatal) lung problems. Lung problems may occur within the first month of treatment or after long-term use of nitrofurantoin (generally for 6 months or longer).
Today, amoxicillin is commonly prescribed as first-line treatment for UTIs in older adults. Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do; or because their side effects can be serious in older adults.
It’s important to note that while UTIs can exacerbate dementia symptoms, they don’t always mean a person has dementia or signal a risk factor for Alzheimer’s.
Use of nitrofurantoin for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms. A very serious allergic reaction to this drug is rare.
You should not take Macrobid if you are allergic to nitrofurantoin, or if you have:
Bottom Line. Bactrim is an effective combination antibiotic; however, it may not be suitable for those with kidney or liver disease or folate deficiency. The risk of side effects may be higher in the elderly.
Nitrofurantoin is an antibiotic that is used for treating urinary tract infections caused by several types of bacteria. It is effective against E. Coli, Enterobacter cystitis, Enterococcus, Klebsiella, and Staphylococcus aureus. Nitrofurantoin interferes with the production of bacterial proteins, DNA, and cell walls.
Nitrofurantoin, sulfonamides, vancomycin, penicillins, and cephalosporins do not penetrate well into the prostate. Antibiotics that penetrate well into the acid milieu of the prostate are nonpolar and lipid-soluble and have a high measure of acid strength, a small molecular radius, and low serum protein binding.
Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin (Macrobid, Macrodantin). More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin (Cetraxal, Ciloxan) and levofloxacin (Levaquin).
Since there is a lower chance of antibiotic resistance with nitrofurantoin and fosfomycin as compared to other classes of antibiotics, they are often used as first-line antibiotics for the treatment of UTI.