Nitrofurantoin

Research summary

Clinical research on nitrofurantoin in humans focuses on its efficacy and safety for treating and preventing uncomplicated urinary tract infections, primarily in otherwise healthy women and, to a lesser extent, men. Randomized controlled trials and large observational studies show that standard 5–7 day courses are effective for acute cystitis, with clinical cure rates typically in the range seen with other first-line agents such as trimethoprim–sulfamethoxazole and fluoroquinolones, while having a relatively favorable resistance profile. Shorter 3-day courses appear less effective symptomatically, even when bacteriological eradication is achieved. Safety data from trials, post-marketing surveillance, and pharmacovigilance reports indicate that nitrofurantoin is generally well tolerated in short courses in otherwise healthy adults, with common adverse effects including gastrointestinal upset and headache. Rare but serious toxicities such as pulmonary reactions, hepatotoxicity, peripheral neuropathy, and hematologic abnormalities are documented, especially with long-term prophylactic use, in older adults, or in individuals with renal impairment or other comorbidities. There is no evidence or rationale to support the use of nitrofurantoin for performance, longevity, or other health-optimization purposes in healthy people.