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However, in the 2015 AGS Beers Criteria the threshold for creatinine clearance concern was decreased to 30m L/min for nitrofurantoin because of questions about the old evidence regarding nitrofurantoin excretion and new, albeit low quality, evidence for effectiveness.3 Two studies support use of nitrofurantoin in older women for treatment of UTI.

The most recent study was a retrospective cohort study that compared use of nitrofurantoin and trimethoprim in women with renal impairment and a UTI.4 Inclusion criteria were women greater than 18 years of age who received a prescription for nitrofurantoin or trimethoprim for a treatment of a UTI which was defined as (1) no antibacterial treatment six-months prior to receiving either treatment, (2) at least a one- year medication history prior to the antimicrobial starting date, and (3) a six-month follow up medication history after starting the antimicrobial therapy. “Ineffectiveness and Adverse Events of Nitrofurantoin in Women with Urinary Tract Infection and Renal Impairment in Primary Care.” European Journal of Clinical Pharmacology Eur J Clin Pharmacol 69.9 (2013): 1701-707.

Exclusion criteria included patients with antibacterial use less than three days or greater than ten days.

The primary outcome was treatment failure defined as starting a second antibiotic for treatment of a UTI within one month. v=1&t=ijkhj451&s=034b8ee90406aeba02f3ceb2d969e01d3b9c7e7c 4.

Census Bureau data, there are some 76.4 million people in the “baby boomer” generation (born between 19).

The increasing number of older adults requires clinicians to consider the unique care needs of geriatric patients — and that includes appropriate medication therapies.

Adverse effects of nitrofurantoin include pulmonary toxicity, hepatic dysfunction, peripheral neuropathy, hemolytic anemia, and Clostridium difficile-associated diarrhea.For nitrofurantoin users the risk of an adverse event was significantly higher in patients with renal impairment, defined as a GFR less than 50 m L/min/1.73m2. These results indicate that nitrofurantoin reaches therapeutic effects in the urine for bactericidal activity at least as effective as trimethoprim. “2012 Beers Criteria.” Journal of the American Geriatrics Society 60.4 (2012): 612-13. The secondary outcome was hospitalization due to adverse effects. For nitrofurantoin, the overall incidence for ineffective treatment was 14.4% as compared to 16.6% for trimethoprim. “American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.” Journal of the American Geriatrics Society 63.11 (2015): 2227-246.

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