Nitrofurantoin (Paediatric — UTI Prophylaxis)

How it works

It is reduced by bacterial enzymes to reactive intermediates that damage bacterial DNA, ribosomal proteins and other macromolecules, concentrating in the urine to act at the site of infection.

Prescribing in practice

• The most important paediatric concern is that nitrofurantoin must be avoided in infants in the first few months of life and is contraindicated in significant renal impairment, where reduced urinary concentration cuts efficacy and the risk of toxicity rises, and it carries a risk of haemolysis in G6PD deficiency.
• It treats lower urinary tract infection only and is not suitable for pyelonephritis or systemic infection because it does not reach adequate tissue concentrations.
• Long-term prophylactic use requires periodic review for the rare risks of pulmonary and hepatic reactions; doses should be confirmed against a children's formulary.

Monitoring

Monitor for recurrence, and on prolonged prophylaxis review periodically for respiratory, hepatic and neurological adverse effects.

Counselling the patient

• Give with food to improve absorption and reduce stomach upset.
• The urine may turn yellow-brown, which is harmless.
• Report any breathlessness, persistent cough, jaundice or numbness and tingling.

Evidence & guidelines

NICE guidance supports antibiotic prophylaxis, including nitrofurantoin, for selected children with recurrent urinary tract infection, with use avoided in young infants and renal impairment.