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Urinary tract infection (lower) - women - Management
Can nitrofurantoin be prescribed to women who are pregnant or breastfeeding?
- Nitrofurantoin can be used in women who are pregnant or breastfeeding.
- Because it is excreted in milk, avoid breastfeeding during treatment with nitrofurantoin if the newborn is glucose-6-phosphate dehydrogenase deficient.
Basis for recommendation
Safety in pregnancy
- Nitrofurantoin has been used for many years for the prophylaxis and treatment of urinary tract infection and asymptomatic bacteriuria in pregnancy [NTIS, 2005; Schaefer et al, 2007].
- The drug is concentrated in the urinary tract. Consequently, significant transfer across the placenta does not occur.
- Although it is not licensed for use in pregnancy, the manufacturer of nitrofurantoin reported that the drug has been used extensively clinically since 1952 and its suitability in pregnancy has been well documented [Goldshield Pharmaceuticals, 2002a; Goldshield Pharmaceuticals, 2002b]. The efficacy and safety profiles of nitrofurantoin are further supported by a recent large multicentre study undertaken by the World Health Organization (WHO) in which 778 pregnant women with asymptomatic bacteriuria were treated with nitrofurantoin [Lumbiganon et al, 2009].
- There have been no reports of increased risk of congenial malformations [Schaefer et al, 2007].
- Haemolytic reactions are rare. There has been one case report of haemolytic anaemia in a newborn baby (with glucose-6-phosphate dehydrogenase deficiency) after in utero exposure to nitrofurantoin [Bruel et al, 2000; Schaefer et al, 2007].
Breastfeeding
- Nitrofurantoin may be used in women who are breastfeeding [Schaefer et al, 2007].
- Because it is excreted in milk, there is a potential to cause haemolytic anaemia in newborns who are glucose-6-phosphate dehydrogenase deficient. However, this is rare, and only one case report has been documented [Schaefer et al, 2007]. The recommendation to temporarily cease breastfeeding is pragmatic advice.
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