Think before you prescribe
Do not give nitrofurantoin in
suspected pyelonephritis
Nitrofurantoin
is an effective and therefore often the first-line choice for cystitis. A 2010
update of the guidelines for the treatment of acute uncomplicated cystitis and
pyelonephritis (Clin Infect Dis. 2011;52:e103-e120) recommends against
the use of nitrofurantoin when the diagnosis of cystitis is uncertain vis-à-vis
pyelonephritis, because it does not achieve adequate renal tissue levels. According
to the guideline, “such uncertainly may exist in the setting of cystitis
symptoms accompanied by subjective fever that is not verified at the time of
examination, a prolonged duration of cystitis symptoms (typically greater than
5-7 days), or vague flank pain or tenderness which is not otherwise explained”.
In such
cases, a urine culture and susceptibility test should always be done and choice
of antibiotic should be based on the culture
and antibiotic sensitivity testing. Local community resistance
prevalence, availability, cost, patient allergy and compliance history are
other factors that may influence the choice of antibiotic in these patients.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA
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