Macrobid and Urinary Tract Infections

Are you at risk for a UTI?
According to the American Congress of Obstetricians and Gynecologists (ACOG) Guidelines, risk factors for Premenopausal and Postmenopausal women include the following:

Premenopausal Women
  • History of UTI
  • Frequent or recent sexual activity
  • Diaphragm contraception use
  • Use of spermicidal agents
  • Increasing parity
  • Diabetes mellitus
  • Obesity
  • Sickle cell trait
  • Anatomic congenital abnormalities
  • Urinary tract calculi
  • Neurologic disorders or medical conditions requiring indwelling or repetitive bladder catheterization
Postmenopausal Women
  • Vaginal atrophy
  • Incomplete bladder emptying
  • Poor perineal hygiene
  • Rectocele, cystocele, urethrocele, or uterovaginal prolapse
  • Lifetime history of UTI
  • Type 1 diabetes mellitus

Every year, urinary tract infections account for nearly 10 million doctor visits. A urinary tract infection (UTI) occurs when bacteria (germs) enter the urinary tract and multiply. One in five women will have at least one urinary tract infection in her lifetime. (Reference: “A to Z Health Guide”; The National Kidney Foundation

There are several antibiotics used to treat UTIs, but if your infection becomes resistant to antibiotics, or if you have a sulfa allergy, you may want to ask your doctor about Macrobid. Macrobid is a proven oral antibiotic with relatively low resistance, making it an effective choice for treating urinary tract infections (asymptomatic bacteriuria and uncomplicated UTIs). Talk with your doctor to see if Macrobid might be right for you.

Symptoms of a Urinary Tract infection

The following symptoms could indicate a urinary tract infection:

A UTI can also produce swelling and pain in the urinary tract, but can also be asymptomatic (asymptomatic bacteriuria). (Reference: “A to Z Health Guide”; The National Kidney Foundation If not treated properly, the bacteria from a UTI can move up to the kidneys and cause a more serious type of infection.


Macrobid is indicated only for the treatment of acute uncomplicated urinary tract infections (acute cystitis) caused by susceptible strains of Escherichia coli or Staphylococcus saprophyticus. Nitrofurantoin is not indicated for the treatment of pyelonephritis or perinephric abscesses. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Macrobid and other antibacterial drugs, Macrobid should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. Nitrofurantoins lack the broader tissue distribution of other therapeutic agents approved for urinary tract infections.

Consequently, many patients who are treated with Macrobid are predisposed to persistence or reappearance of bacteriuria. (See CLINICAL STUDIES.) Urine specimens for culture and susceptibility testing should be obtained before and after completion of therapy. If persistence or reappearance of bacteriuria occurs after treatment with Macrobid, other therapeutic agents with broader tissue distribution should be selected.

In considering the use of Macrobid, lower eradication rates should be balanced against the increased potential for systemic toxicity and for the development of antimicrobial resistance when agents with broader tissue distribution are utilized. Be sure to speak with your healthcare provider about the benefits and potential risks of starting any medical treatment, including treatment with Macrobid.


CONTRAINDICATIONS: Anuria, oliguria, or significant impairment of renal function (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine) are contraindications. Treatment of this type of patient carries an increased risk of toxicity because of impaired excretion of the drug. Because of the possibility of hemolytic anemia due to immature erythrocyte enzyme systems (glutathione instability), the drug is contraindicated in pregnant patients at term (38-42 weeks gestation), during labor and delivery, or when the onset of labor is imminent. For the same reason, the drug is contraindicated in neonates under one month of age. Macrobid is contraindicated in patients with a previous history of cholestatic jaundice/hepatic dysfunction associated with nitrofurantoin. Macrobid is also contraindicated in those patients with known hypersensitivity to nitrofurantoin.

PRECAUTIONS: Information for Patients: Patients should be advised to take Macrobid with food (ideally breakfast and dinner) to further enhance tolerance and improve drug absorption. Patients should be instructed to complete the full course of therapy; however, they should be advised to contact their physician if any unusual symptoms occur during therapy. Patients should be advised not to use antacid preparations containing magnesium trisilicate while taking Macrobid. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Macrobid or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.

For more information, read the full prescribing information for Macrobid.