NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

PostScript 79 (Jan 2014) Nitrofurantoin in renal impairment

Safety update: Nitrofurantoin

As we highlighted in September, the MHRA have issued a reminder on precautions for use of nitrofurantoin in renal impairment, following a small number of reports of treatment failure in a single UK centre. In NHSGGC, as in much of the UK, this agent is recommended for lower urinary tract infections in patients without sepsis. Nitrofurantoin concentrates in the urine and has an excellent spectrum of activity against the majority of microbes causing UTI. In patients with renal impairment, secretion is reduced and this may result in treatment failure.


The SPC and MHRA state nitrofurantoin is contraindicated where creatinine clearance < 60ml/min. Advice in GGC Therapeutics Handbook is to avoid in patients with eGFR < 20ml/min/1.73m2 and contact microbiology for an alternative.


The Antimicrobial Management Team is awaiting latest UK guidance from the soon to be updated Renal Drug Handbook before revising local guidance. At present prescribers should be aware of potential treatment failure with nitrofurantoin in those with reduced renal function. Prescribers should also be aware that alternative antibiotics in this population are associated with a significant increased risk of Clostridium difficile and also may have a narrower spectrum of activity against potential organisms causing UTI. These risks should be carefully considered and a measured judgment made for individual patients. It is important to reiterate that asymptomatic bacteriuria is very common in the elderly and is absolutely not an indication for antibiotic therapy.


There will be an update with definitive guidance following further consultation and publication of the Renal Drug Handbook.


Previous article: Smoking cessation: varenicline and depression


Next article: Novel oral anticoagulants