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Generic Name:nitrofurantoin (NYE troe fue RAN toin)
Brand Name:Macrobid, Macrodantin, Nitro Macro

Medically reviewed by Sanjai Sinha, MD. Last updated on April 1, 2020.

What is Macrobid?

Macrobid (nitrofurantoin) is an antibiotic that fights bacteria in the body.

Macrobid is used to treat urinary tract infections.

Macrobid may also be used for purposes not listed in this medication guide.

Warnings

You should not take Macrobid if you have severe kidney disease, urination problems, or a history of jaundice or liver problems caused by nitrofurantoin.

Do not take Macrobid if you are in the last 2 to 4 weeks of pregnancy.

Before taking this medicine

You should not take Macrobid if you are allergic to nitrofurantoin, or if you have:

• severe kidney disease;

• a history of jaundice or liver problems caused by taking nitrofurantoin;

• if you are urinating less than usual or not at all; or

• if you are in the last 2 to 4 weeks of pregnancy.

Do not take Macrobid if you are in the last 2 to 4 weeks of pregnancy.

To make sure Macrobid is safe for you, tell your doctor if you have:

• kidney disease;

• anemia;

• diabetes;

• an electrolyte imbalance or vitamin B deficiency;

• glucose-6-phosphate dehydrogenase (G6PD) deficiency; or

• any type of debilitating disease.

FDA pregnancy category B. Macrobid is not expected to be harmful to an unborn baby during early pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Nitrofurantoin can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are taking Macrobid.

Macrobid should not be given to a child younger than 1 month old.

How should I take Macrobid?

Take Macrobid exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take Macrobid with food.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

You may mix your liquid dose with water, milk, or fruit juice to make it easier to swallow. Drink the entire mixture right away.

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Macrobid will not treat a viral infection such as the common cold or flu.

Macrobid is usually given for 5 days in females and 7 days in males for uncomplicated UTI.

If you use this medicine long-term, for prevention of UTI, you may need frequent medical tests at your doctor's office.

Macrobid can cause unusual results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are using Macrobid.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Avoid using antacids without your doctor's advice. Use only the type of antacid your doctor recommends. Some antacids can make it harder for your body to absorb nitrofurantoin.

Macrobid side effects

Get emergency medical help if you have any of these signs of an allergic reaction to Macrobid: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

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Call your doctor at once if you have:

• diarrhea that is watery or bloody;

• sudden chest pain or discomfort, wheezing, dry cough or hack;

• new or worsening cough, trouble breathing;

• fever, chills, body aches, tiredness, unexplained weight loss;

• numbness, tingling, or pain in your hands or feet;

• liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

• lupus-like syndrome--joint pain or swelling with fever, swollen glands, muscle aches, chest pain, vomiting, unusual thoughts or behavior, and patchy skin color.

Serious side effects may be more likely in older adults and those who are ill or debilitated.

Common Macrobid side effects may include:

• headache, dizziness;

• gas, upset stomach;

• mild diarrhea; or

• vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Dosing information

Usual Adult Dose for Cystitis:

Regular release: 50 to 100 mg orally 4 times a day for 1 week or for at least 3 days after urine sterility is obtained
Dual release: 100 mg orally twice a day for 7 days

Usual Adult Dose for Cystitis Prophylaxis:

Regular release: 50 to 100 mg orally once a day at bedtime

Usual Pediatric Dose for Cystitis:

Regular release:
1 month or older: 5 to 7 mg/kg/day (up to 400 mg/day) orally in 4 divided doses
Dual release:
Greater than 12 years: 100 mg orally twice a day for 7 days

Usual Pediatric Dose for Cystitis Prophylaxis:

Regular release:
1 month or older: 1 to 2 mg/kg/day (up to 100 mg/day) orally in 1 to 2 divided doses

What other drugs will affect Macrobid?

Other drugs may interact with nitrofurantoin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Frequently asked questions

More about Macrobid (nitrofurantoin)

• During Pregnancy or Breastfeeding

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Consumer resources

Other brands

Macrodantin, Furadantin

Professional resources

Related treatment guides

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Macrobid only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2021 Cerner Multum, Inc. Version: 9.02.

WHAT IS MAC (MYCOBACTERIUM AVIUM COMPLEX) AND HOW IS IT DIAGNOSED AND TREATED?

• Formerly known as “atypical mycobacteria”, “atypical TB”, or “atypical AFB” and currently as “nontuberculous mycobacteria” or “NTM”. NTM includes all types or species of mycobacteria (including MAC) other than the germ of tuberculosis (TB).
• Related to Mycobacterium tuberculosis (Mtb) but it is not TB (tuberculosis).
• NTM includes a number of different species, but the most common one causing chronic lung disease is MAC.
• MAC is not spread person to person like Mtb. MAC is not contagious.
• MAC lung disease seen in HIV negative (non-AIDS) patients is a chronic lung infection and early-on is often misdiagnosed as chronic bronchitis or recurrent pneumonia.
• MAC Lung Disease is acquired from the environment (soil, air, natural waters, tap water, etc.)
• Scientists and physicians who have studied MAC believe people who develop MAC lung disease become infected because of a defect in the structure or function of their lungs (especially a disease called bronchiectasis) or in their immune systems.
• Damaged lung tissue can result from previous TB, heavy smoking, and a breathing tube disease called bronchiectasis.
• Bronchiectasis is a breathing tube (bronchial) disorder characterized by excessive mucus production, cough, and susceptibility to certain infections such as MAC or infection caused by bacteria such as Pseudomonas aeruginosa.
• Disease in men commonly relates to smoking while disease in women (non-smoking) usually relates to bronchiectasis.
• The average age of patients with MAC lung disease in men is 55 years and 67 years in women.
• Men are more likely to have cavitary MAC (holes in their lungs). Women are more likely to have non-cavitary, nodular MAC.
• Diagnosis of MAC lung disease usually requires:
• Medical history with records of symptoms:
• Cough, sputum production, shortness of breath
• Loss of appetite (anorexia is the medical term) weight loss
• Severe fatigue or tiredness with inability to perform daily tasks
• Rarely coughing up blood (hemoptysis is the medical term)
• Fever, night sweats
• Chest x-ray (a picture of your lungs internally)
• High resolution CT scan (HRCT) (similar to an x-ray but a more detailed picture)
• Sputum culture – several sputum cultures are usually performed. Your specimen coughed from your lungs is examined under a microscope (AFB smear) and also placed on special media to grow mycobacteria (AFB culture).
• Bronchoscopy – may be necessary in some cases (especially if you can not cough up sputum) but not all, and involves putting a tube down into your lungs to obtain specimens for culture.

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TREATMENT OF MAC LUNG DISEASE REQUIRES A MULTI-DRUG REGIMEN (MORE THAN ONE DRUG).

• MAC is resistant to ordinary antibiotics.
• Combination of 3 drugs (all FDA approved)/dosages are based upon your clinical history, age, weight, and symptoms.
• Clarithromycin (Biaxin) or Azithromycin (Zithromax)
• Rifampin (Rifadin) or Rifabutin (Mycobutin)
• Ethambutol (Myambutol)
• The combination of medicines is given until no more MAC germs can be grown by culture of your sputum for 1 year. Average treatment period is about 15-18 months.
• Monthly sputum cultures are performed while you are on therapy and periodically when you finish your therapy to be sure your MAC is gone.
• The 3-drug treatment may be given 3 times weekly (preferably Monday-Wednesday-Friday) or daily.
• Data from previous treatment trials tells us that most patients (approximately two-thirds) who have no previous treatment of their MAC and who can tolerate the appropriate medicines will get better and be “cured” of their MAC lung disease.
• Patients who have failed a prior drug regimen of > 6 months for their MAC are more likely to fail the standard drug regimen (almost 50%).
• Patients who take the 3-drug regimen for less than 1 year with negative cultures are more likely to relapse with disease with their same MAC strain.
• Patients who fail therapy after taking the 3 medicines are usually required to take additional medicines. Injectables which may be useful include:
• Streptomycin or Amikacin
• Amikacin can also be given by inhalation (aerosolized) and is less toxic when given in this manner.
• Monthly laboratory blood tests that include a complete blood count and comprehensive metabolic panel (CBC and CMP) to check for possible damage to blood cells, kidneys, and liver.
• Most common potential side effects/complications of medicines:
• Clarithromycin : Loss of appetite, diarrhea, nausea, abdominal pain, abnormal liver function tests (blood tests), bitter taste, mild allergic rash.
• Azithromycin : Diarrhea, nausea, abdominal pain, abnormal liver function tests (blood tests), decreased hearing, tinnitus (sounds in ears).
• Rifampin : Nausea, vomiting, liver damage, decreased platelets (cells which clot blood), body secretions (urine primarily) are orange/red.
• Rifabutin : Nausea, vomiting, decreased platelets, decreased white blood cells (cells that fight infection), eye pain (uveitis), diffuse muscle and joint aches, skin pigmentation (yellow).
• Ethambutol : Decrease in vision (especially color vision), blurriness.
• Streptomycin : Kidney damage, sounds in ears (tinnitus), hearing loss, poor balance, numbness, tingling, muscle damage, fever, headache.
• Amikacin : Kidney damage, tinnitus, hearing loss, poor balance.
  If you experience these or other additional problems, you should discuss them with your physician.
• Amikacin by inhalation (aerosolization) decreases toxicity to above adverse events.

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Provide a list of your current medicines to your physician so he can determine any possible contra-indications.

PULMONARY FUNCTION TESTING

What is a pulmonary function test?

Pulmonary function testing is a way to measure your breathing capacity and, therefore is an objective measure of how well you are breathing. There are several types of breathing tests that can be done during pulmonary function testing including spirometry, lung volumes and diffusing capacity. A technician will explain what you need to do during each test and will coach you during the tests to help you give a good effort. All breathing tests require more than one measurement so that you will be asked to make more than one effort for each test. Spirometry is the most commonly performed breathing test. It requires you to take in as deep a breath as possible and then blow out the air in your lungs as forcefully and fully as possible. Spirometry, therefore, measures how much air you breathe in and out and how fast you breathe air in and out. Spirometry is frequently performed at baseline and then after you have inhaled a bronchial dilating drug (breathing medicine) to evaluate the effect of medication on your breathing function. As with all pulmonary function tests, it is very important that you make a maximal effort to insure accurate assessment of your breathing function. Lung volumes are performed while you are sitting in a small chamber called a plethysmograph (or body box) and provide further information about how much air you breathe in and out. You will be asked to perform different breathing techniques such as blowing into a tube while in the chamber. Lung volumes are usually not performed unless there are abnormalities found on spirometry. The diffusing capacity is one measure of how well your lungs move oxygen from the lungs into the blood. The results of pulmonary function testing can tell you and your doctor how much your lungs have been affected by a disease process and help determine if specific therapy can be of benefit to you. They can also be useful for evaluating the effects of a disease or treatment over time. You will be given specific instructions about what to do with your own breathing medications when the breathing tests are scheduled. Pulmonary function testing usually takes between ½ to 1 ½ hour to complete, depending on how many of the pulmonary function tests you are asked to complete.

Also see the http://www.uthct.edu website for further information including on how to arrange a clinic visit for expert consultation on MAC. Other centers that can also provide such consultation are found under the List of Treating Institutions.