From Past to Present: The Enduring Role of Nitrofurantoin in UTI Management

Abstract

Urinary tract infections (UTIs) are a global health concern, with Nitrofurantoin re-emerging as a crucial therapeutic agent. Nitrofurantoin, an FDA-approved antimicrobial, exhibits efficacy against a wide array of Gram-positive and Gram-negative bacteria, primarily targeting lower UTIs. Clinical guidelines globally recommend Nitrofurantoin as one of the first-line therapies for acute uncomplicated cystitis in women, recurrent cystitis, asymptomatic bacteriuria in pregnancy, and cystitis in men and children. Its pharmacokinetics ensures elevated urinary concentrations while maintaining minimal systemic levels, a favorable attribute for treating lower UTIs. Clinical trials consistently demonstrate the efficacy of Nitrofurantoin, yielding high cure rates for UTIs across varied dosages and treatment durations. Nitrofurantoin has been shown its clinical superiority over various comparators in multiple clinical trials. Its negligible
impact on resistance development and multifaceted action mechanisms augment its clinical utility in the face of escalating antibiotic resistance. In summary, Nitrofurantoin is a valuable therapeutic option for UTIs owing to its targeted action, favorable pharmacokinetics, demonstrated efficacy, and relatively low resistance rates. This review encapsulates the role, mechanism of action, antimicrobial spectrum, therapeutic indications, susceptibility rate, resistance patterns, and clinical efficacy of Nitrofurantoin in managing diverse UTIs across demographics.