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Nitrofurantoin Indications & Clinical Uses

Evidence-based guide for pediatric prescribing

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.

Primary FDA-Approved Indications

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.

Acute uncomplicated cystitis

FDA Approved
Children ≥1 month with age-appropriate renal functionHighFirst-line

Not appropriate for febrile UTIs or suspected pyelonephritis because tissue levels are inadequate; obtain urine culture before therapy if possible.

Evidence Sources

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Secondary Clinical Uses

Recurrent UTI prophylaxis in vesicoureteral reflux or bladder dysfunction

Secondary Use
Children with ≥2 febrile UTIs or ≥3 afebrile UTIs per yearModerate

Reassess every 6 months; combine with bladder/bowel dysfunction management and hydration strategies.

Evidence Sources

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Off-Label Uses

Note: Off-label uses may be clinically appropriate based on evidence and expert consensus, but are not FDA-approved for these indications. Always consider the evidence base and document clinical reasoning.

Asymptomatic bacteriuria in pregnant adolescents

Off-Label
Pregnant adolescents in 2nd or 3rd trimester

Nitrofurantoin 100 mg BID for 5 days is acceptable when alternatives unsuitable; avoid at term (38–42 weeks) due to risk of neonatal hemolysis.

Evidence Sources

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•Evidence quality: 80/10
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