difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. difficile produces toxins A and B which contribute to the development of CDAD. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. In considering the use of nitrofurantoin macrocrystals capsules, lower eradication rates should be balanced against the increased potential for systemic toxicity and for the development of antimicrobial resistance when agents with broader tissue distribution are utilized.Ĭlostridium difficile -associated diarrhea:Ĭlostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including nitrofurantoin, and may range in severity from mild diarrhea to fatal colitis. If persistence or reappearance of bacteriuria occurs after treatment with nitrofurantoin macrocrystals capsules, other therapeutic agents with broader tissue distribution should be selected. Urine specimens for culture and susceptibility testing should be obtained before and after completion of therapy. Consequently, many patients who are treated with nitrofurantoin macrocrystals capsules are predisposed to persistence or reappearance of bacteriuria. Nitrofurantoins lack the broader tissue distribution of other therapeutic agents approved for urinary tract infections. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. To reduce the development of drug-resistant bacteria and maintain the effectiveness of nitrofurantoin macrocrystals capsules and other antibacterial drugs, nitrofurantoin macrocrystals capsules should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. Nitrofurantoin is not indicated for the treatment of pyelonephritis or perinephric abscesses. Nitrofurantoin macrocrystals capsules is specifically indicated for the treatment of urinary tract infections when due to susceptible strains of Escherichia coli, enterococci, Staphylococcus aureus, and certain susceptible strains of Klebsiella and Enterobacter species.
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