Uncomplicated cystitis with eGFR > 40 ml/min
Pregnancy: Does not appear to be associated with congenital malformations with first trimester exposure. Recommended to avoid at time of delivery as there is a small increased risk of hemolytic anemia of the newborn.
Breastfeeding: Nitrofurantoin is transferred into breastmilk in very low amounts. Nitrofurantoin therapy is contraindicated when given directly to infants < 1 month of age due to the risk of hemolysis. Theoretically, this risk may also be present for infants exposed to nitrofurantoin via breastmilk however, no reports of hemolytic anemia in a breastfeeding neonate exposed to nitrofurantoin have been located. Caution, particularly in preterm infants and infants < 8 days old. An alternative antibiotic should be considered if possible. Breastfeeding should be avoided in infants with G6PD deficiency. Monitor the infant for signs of jaundice and GI intolerances.
Interstitial pneumonitis and fibrosis especially with prolonged use
Increased liver enzmes
Cannot be used for the treatment of pyelonephritis.
Antimicrobial class: Reduced by bacterial flavoproteins to reactive intermediates that inactivate or alter bacterial ribosomal proteins leading to inhibition of protein synthesis, aerobic energy metabolism, DNA, RNA, and cell wall synthesis. Nitrofurantoin is bactericidal in urine at therapeutic doses.