Adverse Effects
The most common side effects with nitrofurantoin are nausea, vomiting, and diarrhea; less common reactions include fever, chills, and various other hypersensitivity reactions. It can also cause pulmonary fibrosis and Drug-induced autoimmune hepatitis. All these side effects are much more common in the elderly hence this antibiotic is strongly not recommended for older adults according to 2012 AGS Beers Criteria.
Patients should be informed that nitrofurantoin colours urine brown; this is completely harmless.
Neonates (babies up to the age of one month) have immature enzyme systems in their red blood cells (glutathione instability) and nitrofurantoin must therefore not be used because it can cause haemolytic anaemia. For the same reason, nitrofurantoin should not be given to pregnant women after 38 weeks of pregnancy, or who are about to give birth.
Nitrofurantoin is contraindicated in patients with decreased renal function (CrCl < 60mL/min) due to systemic accumulation and subtherapeutic levels reached in the urinary tract. However, a retrospective chart review may suggest that nitrofurantoin is not contraindicated in this population.
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