However, in the 2015 American Geriatric Society Beers Criteria, this threshold was reduced to 30 mL/min because of new data regarding its effectiveness in certain populations with renal impairment. It had always been recommended that nitrofurantoin be avoided in patients with chronic renal insufficiency, defined as a CrCl less than 60 mL/min, because of lack of efficacy from poor renal concentrating ability. Nitrofurantoin should also be avoided in patients with suspicion of or known glucose-6-phosphate dehydrogenase (G6PD) deficiency because it can lead to hemolytic anemia. Nitrofurantoin can cause GI upset and rare pulmonary issues, such as pulmonary fibrosis, when used chronically. Acquired bacterial resistance to this drug is exceedingly low. It has minimal effects on the resident bowel and vaginal flora. Therefore it is not useful for upper tract, complicated infections, or blood-borne infections ( Wilhelm and Edson, 1987). It is rapidly excreted from the urine but does not obtain therapeutic levels in most body tissues, including the gastrointestinal (GI) tract. Nitrofurantoin is effective against most common uropathogens. Partin MD, PhD, in Campbell-Walsh-Wein Urology, 2021 Nitrofurantoin
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