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Macrobid

GENERAL
Half-life: 0.7 to 1.7 hours
Excretion: 40% to 45% urinary
Take with food
May cause dizziness or drowsiness
Do not use antacids with magnesium trisilicate while on macrobid
May turn urine brown
If loose stools or diarrhea develops, discontinue and notify prescribing physician
Category B for pregnancy
Susceptibilities
Lower urinary tract infections from: S aureus, group D Streptococci, Viridans group streptococci, S agalactiae, Citrobacter, Klebsiella, and coagulase negative staphylococci. ​
monitoring
Long term: periodic LFT's, renal function tests, pulmonary function
mechanism
Inactivates ribosomal proteins
medication interactions
Reduced absorption with antacids containing magnesium trisilicate.
Uricosuric drugs (e.g., probenecid, sulfinpyrazone) inhibit renal tubular secretion resulting in increased toxicity with decreased urine macrobid levels
contraindications
Pregnant** at end of term due to hemolytic anemia from glutathione system immaturity
Breastfeeding <3mo or any age w/ G6PD deficiency
<3 mo in age due to hemolytic anemia from glutathione system immaturity
Anuria, oliguria, or significant renal dysfunction CrCl < than 60 mL/min (some sources as low as 45ml/min)
G6PD) deficiency
Acute porphyria
warnings/precautions
Meets BEERS CRITERIA for elderly adults
C. diff reports (as nearly all ABX)
Brown discoloration of the urine.
Hemolytic Anemia: hemolysis in G6PD deficiency found in ~10 percent of Blacks and a small percentage of ethnic groups of Mediterranean and Near-Eastern origin. 
Hepatitis, cholestatic jaundice
Peripheral neuropathy (including optic neuritis), possibly severe or irreversible w/ increased risk if: CrCl <60mL/min, anemia, diabetes, electrolyte imbalance, vitamin B deficiency, and/or debilitating disease.
Pulmonary fibrosis
Reduced sperm count and testicular histology abnormality association
side effects
COMMON (1-10%): Nausea, emesis, anorexia, flatulence, headache, 
UNCOMMON (<1%): Abdominal pain, diarrhea, dyspepsia, constipation, dizziness, drowsiness, blurry vision, fevers, chills, mailase, acute pulmonary hypersensitivity reaction
RARE (<0.1%): Exfoliative dermatitis, erythema multiforme (including Stevens-Johnson syndrome), parotitis, pseudomembranous colitis, cyanosis secondary to methemoglobinemia, aplastic anemia, hepatitis, vertigo, pseudotumor cerebri, optic neuritis, intraretinal crystals causing retinopathy, bulging fontanels, acute interstitial nephritis, cyanosis
VERY RARE (<0.01%):
UNKNOWN PREVALENCE: ST changes, alopecia, dark urine, hemolytic anemia, bone marrow suppression, neuropathy, diplopia, nystagmus, arthralgia, myalgia, confusion, depression, psychotic reaction.​
​
dosage
ADULT
CYSTITIS: Regular release: 50 to 100 mg po q6h x3-7d; Dual release: 100 mg po BID x7d 
UTI PROPHYLAXIS: Regular release: 50 to 100 mg po qhs

PEDIATRIC
CYSTITIS: Regular release >3mo 5 to 7 mg/kg/day (up to 400 mg/day) po q6h x3-7d; Dual release >12yr: 100mg po bid x3-7d
UTI PROPHYLAXIS: >3mo 1 mg/kg/day (up to 100 mg/day) po qd or bid

RENAL DOSING: Do not give if CrCl <60ml/min. No special dosing necessary if >60ml/min.
DIALYSIS: Is dializable
HEPATIC DOSING: May need reduced dosing if hepatic dysfunction
GENERAL
Half-life: 0.7 to 1.7 hours

Excretion: 40% to 45% urinary
Take with food
May cause dizziness or drowsiness
Do not use antacids with magnesium trisilicate while on macrobid
May turn urine brown
If loose stools or diarrhea develops, discontinue and notify prescribing physician
Category B for pregnancy

MECHANISM: Inactivates ribosomal proteins
INDICATION: Lower urinary tract infections from: S aureus, group D Streptococci, Viridans group streptococci, S agalactiae, Citrobacter, Klebsiella, and coagulase negative staphylococci. 

CONTRAINDICATIONS:
Pregnant** at end of term due to hemolytic anemia from glutathione system immaturity
Breastfeeding <3mo or any age w/ G6PD deficiency
<3 mo in age due to hemolytic anemia from glutathione system immaturity
Anuria, oliguria, or significant renal dysfunction CrCl < than 60 mL/min (some sources as low as 45ml/min)
G6PD) deficiency
Acute porphyria

MONITORING
Long term: periodic LFT's, renal function tests, pulmonary function

DRUG INTERACTIONS:
Reduced absorption with antacids containing magnesium trisilicate.
Uricosuric drugs (e.g., probenecid, sulfinpyrazone) inhibit renal tubular secretion resulting in increased toxicity with decreased urine macrobid levels

WARNINGS/PRECAUTIONS:
Meets BEERS CRITERIA for elderly adults
C. diff reports (as nearly all ABX)
Brown discoloration of the urine.
Hemolytic Anemia: hemolysis in G6PD deficiency found in ~10 percent of Blacks and a small percentage of ethnic groups of Mediterranean and Near-Eastern origin. 
Hepatitis, cholestatic jaundice
Peripheral neuropathy (including optic neuritis), possibly severe or irreversible w/ increased risk if: CrCl <60mL/min, anemia, diabetes, electrolyte imbalance, vitamin B deficiency, and/or debilitating disease.
Pulmonary fibrosis
Reduced sperm count and testicular histology abnormality association

SIDE EFFECTS
COMMON (1-10%): Nausea, emesis, anorexia, flatulence, headache, 
UNCOMMON (<1%): Abdominal pain, diarrhea, dyspepsia, constipation, dizziness, drowsiness, blurry vision, fevers, chills, mailase, acute pulmonary hypersensitivity reaction
RARE (<0.1%): Exfoliative dermatitis, erythema multiforme (including Stevens-Johnson syndrome), parotitis, pseudomembranous colitis, cyanosis secondary to methemoglobinemia, aplastic anemia, hepatitis, vertigo, pseudotumor cerebri, optic neuritis, intraretinal crystals causing retinopathy, bulging fontanels, acute interstitial nephritis, cyanosis
VERY RARE (<0.01%):
UNKNOWN PREVALENCE: ST changes, alopecia, dark urine, hemolytic anemia, bone marrow suppression, neuropathy, diplopia, nystagmus, arthralgia, myalgia, confusion, depression, psychotic reaction.​

DOSAGE 
ADULT
CYSTITIS: Regular release: 50 to 100 mg po q6h x3-7d; Dual release: 100 mg po BID x7d 
UTI PROPHYLAXIS: Regular release: 50 to 100 mg po qhs

PEDIATRIC
CYSTITIS: Regular release >3mo 5 to 7 mg/kg/day (up to 400 mg/day) po q6h x3-7d; Dual release >12yr: 100mg po bid x3-7d
UTI PROPHYLAXIS: >3mo 1 mg/kg/day (up to 100 mg/day) po qd or bid

RENAL DOSING: Do not give if CrCl <60ml/min. No special dosing necessary if >60ml/min.
DIALYSIS: Is dializable
HEPATIC DOSING: May need reduced dosing if hepatic dysfunction
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  • Home
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    • Dictations >
      • Circumcision
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        • Cysto-OR
        • Cysto, +/- RPG +/- stent >
          • Cysto w/ b/l RPG
          • Cysto, L RPG
          • Cysto, R RPG
          • Cysto, L stent w/o RPG
          • Cysto, L RPG, L Stent
          • Cysto, R Stent w/o RPG
          • Cysto, R RPG, R Stent
        • Cysto, bladder biopsy
        • Cysto and TRUS Prostate Biopsy (OR)
        • Cysto Botox (F)
        • Individual parts of cystos
      • Prostate Biopsy >
        • Cysto and TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (office)
        • MRI Fusion TRUS Prostate Biopsy
      • Robot Left Radical Nephrectomy
      • Robot Right Radical Nephrectomy
      • Robot Radical Prostatectomy w/ PLND
      • TURBT (M)
      • Ureteroscopy >
        • L U-scope (flex), RPG, (F)
        • R U-scope (flex), RPG, (M)
        • L U-scope,semirigid laser, flex, RPG, stent removal, (F)
      • ESWL >
        • Left Proximal ESWL
        • Left Renal ESWL
        • Right Proximal ESWL
        • Right Renal ESWL
      • TURP
      • Vasectomy
    • Plans >
      • Erectile Dysfunction
      • NMIBC
      • Peyronie's Disease
      • Prostate Cancer
    • Medications >
      • Antibiotics >
        • Bactrim
        • Cephalosporins >
          • Keflex
        • Ciprofloxacin
        • Macrobid
        • Gentamicin
      • Medications and Dialysis
      • Anticoagulation and Antiplatelets
      • 5α-Reductase Inhibitors
      • PDE5i
      • Prostate Cancer Drugs >
        • Abiraterone
        • Androgen Receptor Blockers
        • Pembrolizumab
      • Anticholinergics & β-3 Agonists
      • Estrace
    • Patient Discussions >
      • Prostate Cancer
      • PSA Screening
      • Tobacco Cessation
    • Radiation Exposure
    • Medicolegal
    • Urology Jokes & Quotes
  • Subjects
    • Various Pathology >
      • Neurogenic Bladder/Spinal Cord Injury
      • CKD/ESRD
      • Erectile Dysfunction >
        • IPP
      • Female Urology
      • Hypogonadism
      • Imaging
      • Nocturia
      • Overactive Bladder
      • Trauma
      • Urine Retention
    • Urologic Malignancy >
      • Prostate Cancer >
        • Choosing Therapy
        • Imaging
        • Genomic Testing
        • Locally Advanced and BCR
        • Metastatic Prostate Cancer
        • ADT and Hormonal Therapy
        • Surgery
        • Radiation
        • Adjuvant & Salvage Therapy
        • Prostate Biopsy
        • Studies >
          • Landmark Studies
          • Research
      • Bladder Cancer >
        • MIBC
        • NMIBC >
          • Intravesical Therapy
        • Urine Markers
        • Chemotherapy
        • Metastatic Bladder Cancer
        • Immunotherapy
        • Cystectomy & PLND
        • Variant Histology
        • Trimodal Therapy
        • Post Cystectomy Care (ERAS)
        • Studies
      • Renal Cancer >
        • Work-up
        • Treatment
        • Surgery
        • Renal Cysts
        • Locally Advanced & Metastatic
        • RCC Surveillance
        • Calculators & Nomograms
        • Landmark Studies
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      • Upper Tract UCC >
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        • UTUC Chemotherapy
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      • TURP
      • Urolift
      • Surgical Therapies
      • IPSS
    • Fertility >
      • Imaging and Lab Tests
      • Work-up
      • Surgery
      • Infertility in Spinal Cord Injury
      • Study guide
      • Interventions
      • Studies
    • Infection >
      • Fournier's Gangrene
      • Orchitis
      • UTI
      • Recurrent UTI
    • Incontinence >
      • Artificial Urethral Sphincter
      • Neuromodulation
      • Slings
      • Urethral Bulking
    • Pediatric Urology >
      • Pediatric Infections
      • Pediatric Surgery
      • Pediatric Tumors
      • Pediatric Trauma
    • Reconstruction >
      • Ureteral Stricture
      • Urethral Stricture
      • Studies
    • Other Random Studies >
      • Blood Transfusions
      • Fistula
      • Other studies/notes
  • Procedures
    • Cystectomy
    • Incisions
    • Endoscopic >
      • Cystoscopy
      • Ureteroscopy
      • Ureteral Stenting
    • Female Surgery >
      • Interstim & PTNS
      • Midurethral Sling
      • Sacrocolpopexy
    • Nephrectomy
    • PCNL
    • Prostate Biopsy
    • Radical Prostatectomy
    • Suprapubic Tube (SPT)
    • Urethral Catheters
    • Urodynamics
    • Varicocelectomy
  • Videos
  • Journal Club
    • Top 1000 Urology Journal Articles
    • Top Urology Journal Articles by Decade
    • Landmark Authors
    • Bladder Cancer Journal Club >
      • Landmark Papers
    • Reconstructive Journal Club >
      • Landmark Papers
    • Upper Tract Urothelial Carcinoma