Nitrofurantoin – An effective option for treating UTIs in infants and children

Urinary tract infections (UTIs) are among the most prevalent severe bacterial infections in children, often leading to healthcare visits. Escherichia coli is the primary pathogen––responsible for 80-90% of uncomplicated pediatric UTIs. Effective management aims to eliminate the infection, prevent severe systemic illness, alleviate symptoms, and minimize long-term complications. Various antibiotics, such as – nitrofurantoin, trimethoprim/sulfamethoxazole (TMP-SMX), fluoroquinolones, andcephalosporins, are used to treat acute UTIs in children.

Recently, the high resistance to broad-spectrum antibiotics––especially extended-spectrum β-lactams, carbapenems, and fluoroquinolones––has become a significant issue globally. In this context, nitrofurantoin emerges as a promising alternative for treating both uncomplicated and complicated UTIs – recommended as a first-line agent for acute uncomplicated UTIs. It provides excellent antibacterial activity in the urine and acts as atherapeutic and prophylactic agent.

Studies show nitrofurantoin is more effective than TMP-SMX in preventing recurrent UTIs over six months. It also has a lower recurrence rate and causes fewer resistant bacteria – making it more suitable for preventing recurrent UTIs in children. Evidence depictsa UTI recurrence rate of 36.2% with nitrofurantoin, compared to 63.8% with TMP-SMX. Furthermore, only 37.5% of organisms were found to be resistant to nitrofurantoin, whereas 56% were resistant to TMP-SMX.

Overall, UTIs represent a significant health concern for the pediatric population. With rising antibiotic resistance, nitrofurantoin stands out as an effective and reliable option for both treatment and prevention – ensuring better long-term outcomes for children with recurrent UTIs.

Source: Verma A. Pedia Flash. 2018; 4(1)