UTI drug poses risk for patients 65 and older

Nitrofurantoin has been identified as a high-risk medication in patients age 65 and older based on its side effect profile by the American Geriatric Society and the Centers for Medicare & Medicaid Services. Providence Health Plans now requires prior authorization for use of this drug in patients 65 and older, and we encourage you to consider alternative antibacterial drug therapy when possible for this patient population.

Nitrofurantoin is a synthetic antibacterial nitrofuran derivative used in the treatment and prevention of urinary tract infections, or UTIs, caused by susceptible strains of E. coli, S. aureus, Enterococcus, Klebsiella and Enterobacter.

Contraindications to the use of nitrofurantoin include anuria, oliguria or significant impairment of renal function – specifically, creatinine clearance of less than 60 ml per minute or clinically significant elevated serum creatinine. Seniors treated with this drug are at increased risk for toxicity because of impaired excretion of the drug due to the inherent reduction of renal function that occurs with age. Patients prescribed this medication should be monitored for pulmonary reaction and numbness or tingling in extremities. They also should be tested periodically for both liver and renal function if prescribed nitrofurantoin for long-term use.

Please consider the following alternative treatments for your patients:

  • Beta-lactams (i.e., amoxicillin-clavulanate, cefpodoxime, cefdinir, cefaclor or cephalexin)
  • Sulfamethoxazole or trimethoprim, if patient has noted sulfa allergy
  • Fluoroquinolones (i.e., ciprofloxacin or levofloxacin)
  • Fosfomycin

Selection and duration are based on organism, site of infection, allergy information, medications tried and failed, and reported regional sensitivities. Please note: sulfamethoxazole or trimethoprim are not recommended for empiric therapy if regional resistance is greater than or equal to 20 percent. Fluoroquinolones are not recommended if resistance is greater than 10 percent for that region.