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Pediatric Reference

Nitrofurantoin Side EffectsComprehensive Pediatric Safety Guide

Nitrofurantoin side effects are usually mild but rare pulmonary or hepatic reactions can occur with prolonged use.

4 Categories
5 Clinical Sources
Evidence-Based
Back to Nitrofurantoin Overview

Essential Information

1

Give with food to reduce nausea.

2

Report persistent cough, shortness of breath, or fever during therapy.

3

Call for jaundice or dark urine.

Clinical Overview

Most children experience only GI upset; monitor for respiratory or hepatic symptoms, especially on long courses.

Side Effect Categories

4 Systems

Gastrointestinal

2 documented effects

Total Sources: 2

Nausea

Incidence: Common
Onset: Not specified
mild
1 sources
Duration

Not specified

Management

Administer with food or milk; offer small frequent meals.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Abdominal pain

Incidence: Uncommon
Onset: Not specified
mild
1 sources
Duration

Not specified

Management

Supportive care; ensure hydration.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Pulmonary

1 documented effect

Total Sources: 1

Acute pulmonary reactions

Incidence: Rare
Onset: Within hours to days of therapy
serious
1 sources
Duration

Not specified

Management

Stop drug; provide supportive care and consider steroids.

Monitoring Guidelines

Counsel families to report cough, dyspnea, or fever immediately.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hepatic

1 documented effect

Total Sources: 1

Hepatotoxicity

Incidence: Rare
Onset: Not specified
serious
1 sources
Duration

Not specified

Management

Stop therapy and evaluate liver enzymes.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hematologic

1 documented effect

Total Sources: 1

Hemolytic anemia (G6PD deficiency)

Incidence: Rare
Onset: Not specified
serious
1 sources
Duration

Not specified

Management

Avoid in known deficiency; seek urgent care if pallor, fatigue, or jaundice develops.

Monitoring Guidelines

Monitor for symptom escalation or new adverse effects.

1 clinical sources• PubMed • Clinical Guidelines • FDA

Parent Communication Guide

Age-Appropriate Explanations

Infants (0-12 months)

Nitrofurantoin is rarely used in young infants; if prescribed, give only the measured dose and call if they feed poorly or seem unusually sleepy.

Toddlers (1-3 years)

This medicine keeps bladder germs away. Give it with food or milk to prevent tummy upset and store it out of reach.

Children (4-12 years)

Expect urine to look dark—this is normal. Remind your child to finish every dose and drink extra water unless told otherwise.

Adolescents (13+ years)

Take nitrofurantoin with meals, avoid missing doses, and report any cough, breathing trouble, or yellowing eyes immediately.

Common Parent Concerns

Q: Dark urine

A: This is expected—the medicine itself darkens urine.

When to validate: Call if dark urine comes with pale stools, yellowing eyes, or severe fatigue.

Q: Upset stomach

A: Give with meals or milk and encourage sips of water throughout the day.

When to validate: Contact the care team if vomiting prevents doses or weight-based therapy cannot be completed.

Clinical Decision Support

Severity Assessment Framework

Classify nitrofurantoin reactions with focus on pulmonary toxicity, hepatic injury, and hemolytic anemia risk.

Mild
Indicators: Expected dark urine or mild GI upset, No respiratory or hepatic symptoms, Stable energy level
Action: Continue therapy, reinforce administration with food, monitor hydration.
Moderate
Indicators: Persistent nausea/vomiting, new cough, or exertional dyspnea, Mild scleral icterus or elevated LFTs, Drop in hemoglobin in patients with G6PD risk
Action: Hold medication, obtain pulse oximetry, order hepatic panel and CBC, evaluate for alternate therapy.
Severe
Indicators: Acute pulmonary reactions (fever, chest pain, infiltrates), Severe hepatitis or cholestasis, Hemolytic anemia with jaundice or dark urine
Action: Discontinue immediately, arrange emergency evaluation, initiate supportive care and specialty consultation.

Treatment Decision Guidelines

Immediate Discontinuation

  • Acute pulmonary toxicity (cough, dyspnea, infiltrates)
  • Severe hepatotoxicity or cholestatic jaundice
  • Hemolytic anemia (especially in G6PD deficiency)
  • Hypersensitivity presenting with fever, rash, arthralgias

Consider Alternatives

  • Persistent GI intolerance despite food or probiotic support
  • Renal impairment (CrCl <30 mL/min) limiting urinary concentrations
  • Need for long-term prophylaxis with poor adherence or monitoring capacity

Dose Modification

  • Extended dosing interval for borderline renal function
  • Switch to suspension for children struggling with capsules
  • Review concomitant magnesium trisilicate antacids that reduce absorption

Clinical References

NitrofurantoinMedlinePlus (2024)Drug information

Frequently Asked Questions

Parent and clinician concerns about Nitrofurantoin