pyelonephritis with nitrofurantoin?

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kimchee

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can you use macrobid in pt with clinical presentation of pyelo ? culture sensitivity revealed sensitive to nitrofurantoin and cipro. pt allergic to sulfa.
thanks

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is there absolute contraindication to use macrobid (ie nitrofurantoin) for pyelonephritis even if it is sensitive?
 
is there absolute contraindication to use macrobid (ie nitrofurantoin) for pyelonephritis even if it is sensitive?


You would likely use the cipro IV for a day or two. Oral nitrofurantoin (IV nitrofurantoin isn't marketed, not sure if that is for pharmacokinetic reasons or simply because it has no utility) just isn't a strong enough abx to use in a patient with pyelo who has the potential of developing sepsis.
 
This might be the reason why IV nitrofurantoin is not available (metabolic acidosis potential)...from a 1958 article in Pediatrics

Fatality From Intravenous Nitrofurantoin

AVRON Y. SWEET M.D.1


1 Department of Pediatrics, Mount Sinai Hospital, New York, New York

Recently one patient died and another came near death because of severe metabollic acidosis following the administration of Furadantoin® Intravenous Solution. (The brochure accompanying the medication does not indicate that metabolic disturbances might result from its use.) Both patients were adults with severe and extensive paralysis due to poliomyelitis and marked respiratory paralysis as well. Both had renal calculi and urinary tract infections with bacteria which were resistant to all but the more toxic antibacterial agents.
 
The problem with nitrofurantoin is the fact it doesn't penetrate the renal parenchyma from what I've read. It has very little blood concentration once enters the blood stream and most is metabolized by the liver, but some 25% is left unmetabolized and excreted in the urine where it's toxic to the E.coli, and thus used to treat only simple cystitis, not pyelonephritis. Hope that helps.
 
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