Nitrofurantoin is an antibiotic drug. It is only useful in the treatment of cystitis.

Pharmacology

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Organisms are said to be susceptible to nitrofurantoin if their MIC is 32mcg/ml or less. The peak blood concentration of nitrofurantoin following an oral dose of nitrofurantoin 100mg, is less than 1 microgram/ml and may be undetectable; tissue penetration is negligible; the drug is well concentrated in the urine: 75% of the dose is rapidly metabolised by the liver, but 25% of the dose is excreted in the urine unchanged, reliably achieving levels of 200 μg/ml or more. For this reason, nitrofurantoin cannot be used to treat anything other than simple cystitis.

At the concentrations achieved in urine, nitrofurantoin is bacteriocidal. The mechanism of action of nitrofurantoin is unique and complex. The drug works by damaging bacterial DNA, since its reduced form is highly reactive. This is made possible by the rapid reduction of nitrofurantoin inside the bacterial cell by flavoproteins (nitrofuran reductase) to multiple reactive intermediates that attack ribosomal proteins, DNA respiration, pyruvate metabolism and other macromolecules within the cell. It is not known which of the actions of nitrofurantoin is primarily responsible for its bacteriocidal acitivity.

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