Special Drugs For Urinarytract Infections

General antimicrobials are used for urinary tract infections and described elsewhere. A few agents are used solely for infection of the urinary tract:

Nitrofurantoin, a synthetic antimicrobial, is active against the majority of urinary pathogens except pseudomonads. It is well absorbed from the gastrointestinal tract and is concentrated in the urine (t'/2 1 h); but plasma concentrations are too low to treat infection of kidney tissue. Excretion is reduced when there is renal insufficiency, rendering the drug both more toxic and less effective. The main use of nitrofurantoin is now for prophylaxis. Adverse effects include nausea and vomiting (much reduced with the macrocrystalline preparation) and diarrhoea. Peripheral neuropathy occurs especially in patients with significant renal impairment, in whom the drug is contraindicated. Allergic reactions include rashes, generalised urticaria and pulmonary infiltration with lung consolidation or pleural effusion. It is safe in pregnancy, except near to term because it may cause neonatal haemolysis, and it must be avoided in patients with glucoses-phosphate dehydrogenase deficiency (see p. 123).

Nalidixic acid: see page 233.

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