Trimethoprim v Nitrofurantoin (Macrobid)

If you have ever had a constant urgency to pee, or a burning sensation when urinating, cramping in the lower stomach, pain around the pelvis or lower back, you will most likely have shared the pain felt by millions of people (mostly women) who have had a urinary tract infection at some point in their lives.

We mention “mostly women” as men have a lower risk of developing a urinary tract infection (also commonly known as cystitis) mainly for biological reasons.

A woman’s urethra is a lot shorter and closer to their anus than a man’s, making it easier for bacteria to be transferred.

The cause of urinary tract infections (UTI’s) is almost always a bacterium, and the most effective treatment for cystitis is a short course of antibiotics.

In this blog, we will be comparing the two most commonly prescribed antibiotics for UTI’s Trimethoprim and Nitrofurantoin, and seeing if one is any better than the other.

Nitrofurantoin

• Commonly used to treat urinary tract infections (UTIs), including cystitis and kidney infections.
• Nitrofurantoin is rapidly excreted from the blood stream, and into the urine, making it very effective at treating a urinary tract infection, as the medication gets concentrated at the site of the infection.
• It also means that it is not very effective at treating any other types of infection.
• The most common side effect of Nitrofurantoin is an upset stomach.
• (Taking this medicine with or straight after food will help prevent a stomach upset).
• Nitrofurantoin may turn pee dark yellow or brown. This is quite normal. Pee will return to normal after you finish taking the medicine.
• Nitrofurantoin is also called by the brand names Macrobid and Macrodantin
• Nitrofurantoin is suitable for use by pregnant and breastfeeding women.

Nitrofurantoin isn’t suitable for those who:

• Have ever had an allergic reaction to nitrofurantoin
• Have either of the rare inherited conditions: porphyria (a blood disorder) or glucose-6-phosphate dehydrogenase (G6PD) deficiency
• Have severe kidney disease or poor kidney function
• Diabetes
• Anaemia or vitamin B deficiency

Trimethoprim

• It’s used to treat urinary tract infections (UTIs), such as cystitis.
• Occasionally, trimethoprim is used to treat other types of infections, such as chest infections and acne.
• Trimethoprim is usually taken twice a day to treat infections.
• Side effects may include itching or a mild skin rash, but these are usually mild and short-lived.
• Both adults and children can take Trimethoprim.

Trimethoprim isn’t suitable for those who:

• – Have ever had an allergic reaction to trimethoprim
• – Have liver or kidney problems
• – Have anaemia or low amounts of folic aid (folates) in your blood
• – Have porphyria (a rare inherited blood disorder) or any other blood disorder
• – Are trying to get pregnant or already pregnant
• The dose of trimethoprim you need to take depends on your illness, your age, and how well your kidneys work.

Doses are usually lower for elderly people and those with kidney problems.

It’s very important that you continue taking trimethoprim until your course is finished, even if you feel better, to help stop the infection coming back.

Previously Trimethoprim was recommended as first line treatment but increased resistance to its effectiveness has meant that Nitrofurantoin has become the preferred choice.

NICE (national institute of clinical excellence) have recommended that the first choice antibiotic for an uncomplicated urinary tract infection (UTI), is Nitrofurantoin if you are not suffering from poor kidney function, or alternatively Trimethoprim (if there is a low risk of resistance to it where you live).

Access Doctor goes with national guidelines and recommends Nitrofurantoin to women with confirmed UTI or cystitis, but if Trimethoprim is deemed to be more appropriate by our doctors, we will suggest changing over.

Our doctors will review your completed medical questionnaire for cystitis and decide which antibiotic is most appropriate for you.

We only treat women with typical symptoms of cystitis when there is no concern that the infection has extended beyond the bladder. This is defined as acute simple cystitis. When there is concern that the infection has spread we consider this to be a complicated UTI and needs referral to the GP urgently.