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Nitrofurantoin is a urinary antiseptic used for uncomplicated lower UTIs and prophylaxis in children who can concentrate urine effectively.
Use only if creatinine clearance is ≥30 mL/min/1.73 m^2; avoid in significant renal impairment.
Contraindicated in infants under 1 month due to hemolytic anemia risk.
Take with food to improve absorption and limit GI upset; warn families about harmless urine discoloration.
Long-term prophylaxis requires monitoring for hepatic, pulmonary, and neurologic adverse effects.
Avoid in G6PD deficiency due to hemolysis risk.
Nitrofurantoin concentrates in urine, making it ideal for lower urinary tract infections (UTIs) but ineffective for pyelonephritis or systemic disease. Ensure renal function is adequate before prescribing.
Use nitrofurantoin for susceptible acute cystitis and, in select cases, as low-dose prophylaxis for recurrent UTIs. Avoid when creatinine clearance is <30 mL/min/1.73 m² or when pyelonephritis is suspected.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Uncomplicated lower urinary tract infection | Children >1 month with normal renal function | Yes | Give 5–7 mg/kg/day divided every 6 hours (macrocrystals) for 5–7 days when uropathogen susceptibility is confirmed. |
| Nightly prophylaxis for recurrent UTIs | Children and adolescents | Yes | Use 1–2 mg/kg at bedtime with periodic reassessment of need and monitoring for adverse effects. |
| Treatment of asymptomatic bacteriuria in pregnancy | Pregnant adolescents | No | Preferred when pathogens are susceptible and no near-term delivery risk; avoid at term due to hemolytic anemia risk in neonates. |
FDA-approved primary uses with Level A evidence
Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Nitrofurantoin side effects are usually mild but rare pulmonary or hepatic reactions can occur with prolonged use.
Most children experience only GI upset; monitor for respiratory or hepatic symptoms, especially on long courses.
Nausea
Common • mild
Abdominal pain
Uncommon • mild
Acute pulmonary reactions
Rare • serious
Hepatotoxicity
Rare • serious
Hemolytic anemia (G6PD deficiency)
Rare • serious
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Administration considerations for nitrofurantoin treatment and prophylaxis.
Shake the suspension well before measuring. Give with meals or milk. Capsules should be swallowed whole; sprinkle the contents on applesauce if a child cannot swallow capsules.
Encourage your child to drink plenty of fluids and empty the bladder regularly. Urine may turn dark yellow or brown.
Emergency contact: Seek urgent care for breathing difficulties, persistent cough, chest pain, skin rash with hives, or yellowing eyes/skin.
Consistency matters—take doses exactly as prescribed and complete the course even if symptoms improve quickly.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Nitrofurantoin is reduced by bacterial flavoproteins into reactive intermediates that damage DNA, ribosomal proteins, and metabolic enzymes within urinary pathogens.
Because reduction is more efficient in acidic urine, nitrofurantoin achieves bactericidal concentrations in the bladder while maintaining low serum levels. It disrupts multiple pathways simultaneously, limiting resistance development.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Nitrofurantoin works best when dosing is weight-appropriate, urine is acidic, and monitoring for rare pulmonary or hepatic events is in place.
Share these pearls with families to improve adherence and safety during therapy.
Take with meals to decrease GI upset and increase urinary drug concentrations; avoid antacids containing magnesium trisi…
For recurrent UTI prophylaxis, dosing at bedtime maximizes overnight bladder dwell time and improves adherence.
Urine may turn dark yellow or brown—reassure families this is benign unless accompanied by flank pain or decreased outpu…
Acute cough, fever, or dyspnea require immediate evaluation; stop the drug and assess for interstitial pneumonitis, espe…
Core insights every provider should know
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Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Nitrofurantoin and monitor your child's response to treatment.
No. Complete the full course to clear the infection and prevent resistance. Stopping early increases the chance the UTI returns quickly.
Yes. Brown or yellow urine is expected and harmless. Encourage hydration. Call only if urine becomes red or your child develops pain.
No. Nitrofurantoin concentrates in the bladder. Fever, flank pain, or vomiting needs urgent evaluation for pyelonephritis and IV antibiotics.
Short courses rarely require labs. Long-term prophylaxis may involve periodic liver enzymes, pulmonary assessments, and urine cultures per clinician guidance.