Nitroren tablets (Nitrofurantoin) is an antibacterial that acts on most gram-positive and gram-negative urinary tract pathogens. It is effective against the enterococci in vitro as well as various other Gram-positive species including staphylococci, streptococci, and coryne bacteria. Most strains of Escherichia coli are particularly sensitive to nitrofurantoin.
Nitrofurantoin is used in the treatment of uncomplicated lower urinary-tract infections, including for prophylaxis or long term suppressive therapy in recurrent infection.
Mechanism of Action
The mode of action appears to depend on the formation of reactive intermediates by reduction Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules.
Gastro-intestinal tract effects are dose-related and generally include; nausea, vomiting and anorexia, abdominal pain and diarrhoea. Neurological adverse effects include headache, drowsiness, vertigo, dizziness, nystagmus and intracranial hypertension. Hypersensitivity reactions such as skin rashes, urticaria, pruritus, fever and angioedema may occur. Acute pulmonary sensitivity reactions characterized by sudden onset of fever, chills, eosinophilia cough, chest pain, dyspnoea, pulmonary infiltration or consolidation and pleural effusion.
It is also contra-indicated in patients known to be hypersensitive to nitrofurans and in those with a deficiency of glucose -6-phosphate dehydrogenase and in infants less than three months old. Care is required in patients with pre-existing pulmonary, hepatic, neurological or allergic disorders and those with condition (such as anaemia, diabetes mellitus, electrolyte imbalance, debility or vitamin B deficiency) which may predispose to peripheral neuropathy
Nitrofurantoin and the quinolone antibacterials are antagonistic in vitroand should not be used together. The antibacterial activity of nitrofurantoin may be decreased in the presence of carbonic anhydrase inhibitors and other drugs that alkalinize the urine. Probenecid or sulfinpyrazone should not be given with nitrofurantoin as they may reduce its excretion. Magnesium trisilicate may reduce the absorption of nitrofurantoin.
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