Nitrofurantoin works best when dosing is weight-appropriate, urine is acidic, and monitoring for rare pulmonary or hepatic events is in place.
Take with meals to decrease GI upset and increase urinary drug concentrations; avoid antacids containing magnesium trisilicate.
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 output.
Acute cough, fever, or dyspnea require immediate evaluation; stop the drug and assess for interstitial pneumonitis, especially with prolonged courses.