Nitrofurantoin: new advice on use in renal impairment

Nitrofurantoin can now be used in patients with moderate renal impairment.

Prescribers should consider checking renal function when choosing to treat with nitrofurantoin, especially in the elderly.

Until recently, use of nitrofurantoin was contraindicated in patients with an estimated glomerular filtration rate (eGFR) less than 60ml/min/1.73m2. However, the latest advice from the MHRA states that the drug can now be used in patients with an eGFR greater than 45ml/min/1.73m2.

Following a review of the evidence, the MHRA concluded that, in the context of increasing resistance of lower urinary tract pathogens to standard therapy and the risk of Clostridium difficile colitis associated with widespread use of alternative broad-spectrum antibiotics, the eGFR cut-off of 60ml/min/1.73m2 was no longer supported.

In certain instances nitrofurantoin may also be prescribed for patients with an eGFR of 30 to 44ml/min/1.73m2. Use in such patients should be limited to a short course of 3—7 days for the treatment of lower UTI with suspected or proven multidrug-resistant pathogens where the benefits of nitrofurantoin are considered to outweigh the risk of adverse effects.

Further information: MHRA Drug Safety Update, September 2014

Follow MIMS on Twitter

Sign up for MIMS bulletins

Want news like this straight to your inbox?
Sign up for our bulletins

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Already registered?
Sign in

More from MIMS

Products coming soon - live tracker

EXCLUSIVE TO SUBSCRIBERS Monitor forthcoming UK drug...

Deleted products - live tracker

EXCLUSIVE TO SUBSCRIBERS See the latest products removed...

Drug shortages - live tracker

EXCLUSIVE TO SUBSCRIBERS Use our constantly updated...

Pregnant woman having an ultrasound scan with a female sonographer

Valproate prescribing: plan for new regulatory measures without delay, instructs MHRA

A National Patient Safety Alert (NatPSA) has been issued...