▶Child 12–17 years: 50 – 100 mg once daily, dose to be
taken at night
Genito-urinary surgical prophylaxis
▶BY MOUTH USING MODIFIED-RELEASE MEDICINES
▶Child 12–17 years: 100 mg twice daily on day of
procedure and for 3 days afterlCONTRA-INDICATIONSAcute porphyrias p. 603 .G6PD
deficiency.infants less than 3 months old
lCAUTIONSAnaemia.diabetes mellitus.electrolyte
imbalance.folate deficiency.pulmonary disease.
susceptibility to peripheral neuropathy.urine may be
coloured yellow or brown.vitamin B deficiency
lINTERACTIONS→Appendix 1 : nitrofurantoin
lSIDE-EFFECTSAgranulocytosis.alopecia.anaemia.
angioedema.aplastic anaemia.appetite decreased.
arthralgia.asthenia.chest pain.chills.circulatory
collapse.confusion.cough.cyanosis.depression.
diarrhoea.dizziness.drowsiness.dyspnoea.eosinophilia
.euphoric mood.fever.granulocytopenia.haemolytic
anaemia.headache.hepatic disorders.idiopathic
intracranial hypertension.increased risk of infection.
leucopenia.lupus-like syndrome.nausea.nerve disorders
.nystagmus.pancreatitis.psychotic disorder.pulmonary
hypersensitivity.pulmonary reaction (possible association
with lupus erythematosus-like syndrome).respiratory
disorders.skin reactions.Stevens-Johnson syndrome.
thrombocytopenia.urine discolouration.vertigo.
vomiting
lPREGNANCYAvoid at term—may produce neonatal
haemolysis.
lBREAST FEEDINGAvoid; only small amounts in milk but
enough to produce haemolysis in G 6 PD-deficient infants.
lHEPATIC IMPAIRMENTUse with caution; cholestatic
jaundice and chronic active hepatitis reported.
lRENAL IMPAIRMENTRisk of peripheral neuropathy;
antibacterial efficacy depends on renal secretion of the
drug into urinary tract. Avoid if estimated glomerular
filtration rate less than 45 mL/minute/ 1. 73 m^2 ; may be
used with caution if estimated glomerularfiltration rate
30 – 44 mL/minute/ 1. 73 m^2 as a short-course only ( 3 to
7 days), to treat uncomplicated lower urinary-tract
infection caused by suspected or proven multidrug
resistant bacteria and only if potential benefit outweighs
risk.
lMONITORING REQUIREMENTSOn long-term therapy,
monitor liver function and monitor for pulmonary
symptoms (discontinue if deterioration in lung function).
lEFFECT ON LABORATORY TESTSFalse positive urinary
glucose (if tested for reducing substances).
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Nitrofurantoin for urinary tract
infectionswww.medicinesforchildren.org.uk/nitrofurantoin-for-
urinary-tract-infectionslMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
CAUTIONARY AND ADVISORY LABELS9, 14, 21
▶Nitrofurantoin (Non-proprietary)
Nitrofurantoin 50 mgNitrofurantoin 50 mg tablets| 28 tabletP
£ 35. 00 DT = £ 11. 36 | 100 tabletP£ 40. 57 – £ 111. 89
Nitrofurantoin 100 mgNitrofurantoin 100 mg tablets|
28 tabletP£ 12. 99 DT = £ 8. 13 | 100 tabletP£ 22. 14 – £ 29. 04
▶Genfura(Genesis Pharmaceuticals Ltd)
Nitrofurantoin 50 mgGenfura 50 mg tablets| 28 tabletP£ 8. 00
DT = £ 11. 36 | 100 tabletP£ 28. 57
Nitrofurantoin 100 mgGenfura 100 mg tablets| 28 tabletP
£ 8. 50 DT = £ 8. 13 | 100 tabletP£ 30. 36Oral suspension
CAUTIONARY AND ADVISORY LABELS9, 14, 21
▶Nitrofurantoin (Non-proprietary)
Nitrofurantoin 5 mg per 1 mlNitrofurantoin 25 mg/ 5 ml oral
suspension sugar free sugar-free| 300 mlP£ 446. 95 DT =
£ 446. 95
Modified-release capsule
CAUTIONARY AND ADVISORY LABELS9, 14, 21, 25
▶Macrobid(AMCo)
Nitrofurantoin 100 mgMacrobid 100 mg modified-release capsules
| 14 capsuleP£ 9. 50 DT = £ 9. 50
Capsule
CAUTIONARY AND ADVISORY LABELS9, 14, 21
▶Nitrofurantoin (Non-proprietary)
Nitrofurantoin 50 mgNitrofurantoin 50 mg capsules|
30 capsuleP£ 15. 42 DT = £ 15. 42
Nitrofurantoin 100 mgNitrofurantoin 100 mg capsules|
30 capsuleP£ 10. 42 DT = £ 10. 423 Fungal infection
Antifungals, systemic use
Fungal infections
The systemic treatment of common fungal infections is
outlined below; specialist treatment is required in most
forms of systemic or disseminated fungal infections. Local
treatment is suitable for a number of fungal infections
(genital, bladder, eye, ear, oropharynx, and skin).Aspergillosis
Aspergillosis most commonly affects the respiratory tract
but in severely immunocompromised patients, invasive
forms can affect the heart, brain, and skin. Voriconazole
p. 377 is the treatment of choice for aspergillosis; liposomal
amphotericin p. 373 is an alternativefirst-line treatment
when voriconazole cannot be used. Caspofungin p. 372 or
itraconazole p. 375 can be used in patients who are
refractory to, or intolerant of voriconazole and liposomal
amphotericin. Itraconazole is also used for the treatment of
chronic pulmonary aspergillosis or as an adjunct in the
treatment of allergic bronchopulmonary aspergillosis
[unlicensed indication].Candidiasis
Many superficial candidal infections, including infections of
the skin, are treated locally. Systemic antifungal treatment is
required in widespread or intractable infection. Vaginal
candidiasis can be treated with locally acting antifungals;
alternatively,fluconazole p. 374 can be given by mouth.
Oropharyngeal candidiasisgenerally responds to topical
therapy. Fluconazole is given by mouth for unresponsive
infections; it is reliably absorbed and is effective.
Itraconazole may be used for infections that do not respond
tofluconazole. Topical therapy may not be adequate in
immunocompromised children and an oral triazole
antifungal is preferred.
Forinvasive or disseminated candidiasis, either
amphotericin by intravenous infusion or anechinocandin
can be used. Fluconazole is an alternative forCandida
albicansinfection in clinically stable children who have not
received an azole antifungal recently. Amphotericin should
be considered for the initial treatment of CNS candidiasis.
Voriconazole can be used for infections caused by
fluconazole-resistantCandidaspp. when oral therapy is
required, or in children intolerant of amphotericin or an
echinocandin. In refractory cases,flucytosine p. 378 can be
used with intravenous amphotericin.
Cryptococcosis
Cryptococcosis is uncommon but infection in the
immunocompromised, especially in HIV-positive patients,370 Fungal infection BNFC 2018 – 2019
Infection5