Comparative Pharmacology
Head-to-head clinical analysis: NITROFURANTOIN versus SEPTRA.
Peer-Reviewed Evidence
Head-to-head clinical analysis: NITROFURANTOIN versus SEPTRA.
NITROFURANTOIN vs SEPTRA
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates that inactivate or inhibit bacterial ribosomal proteins, DNA, RNA, and metabolic enzymes, leading to bacterial cell death.
SEPTRA (trimethoprim/sulfamethoxazole) is a combination of two antifolate agents: sulfamethoxazole inhibits dihydropteroate synthase, blocking the conversion of PABA to dihydrofolic acid; trimethoprim inhibits dihydrofolate reductase, preventing the reduction of dihydrofolic acid to tetrahydrofolic acid. This sequential blockade disrupts bacterial folate synthesis and nucleic acid production.
100 mg orally twice daily for 5-7 days (uncomplicated UTI); 50-100 mg orally four times daily for 7 days (symptomatic uncomplicated UTI). Extended-release: 100 mg orally twice daily for 7 days.
Trimethoprim-sulfamethoxazole (TMP-SMX) 160 mg/800 mg (double strength) orally every 12 hours; for severe infections, intravenous dosing: 8-10 mg/kg/day (TMP component) divided every 6, 8, or 12 hours.
None Documented
None Documented
Clinical Note
moderateNitrofurantoin + Norfloxacin
"The therapeutic efficacy of Norfloxacin can be decreased when used in combination with Nitrofurantoin."
Clinical Note
moderateNitrofurantoin + Teriflunomide
"The serum concentration of Teriflunomide can be increased when it is combined with Nitrofurantoin."
Clinical Note
moderateNitrofurantoin + Probenecid
"The serum concentration of Probenecid can be increased when it is combined with Nitrofurantoin."
Clinical Note
moderateNitrofurantoin + Rolapitant
Normal renal function: 20-60 minutes; impaired function: prolonged up to 1-2 hours, clinically significant due to urinary concentration requirement
Sulfamethoxazole: 9-12 hours (normal renal function); Trimethoprim: 8-11 hours (normal renal function). In severe renal impairment (CrCl <15 mL/min), half-life prolongs significantly (up to 24-30 hours for sulfamethoxazole, 20-30 hours for trimethoprim).
Renal: ~40% unchanged via glomerular filtration and tubular secretion, biliary/fecal: <1%
Renal excretion of unchanged sulfamethoxazole (~20%) and trimethoprim (~50-60%) with additional hepatic metabolism (acetylation, glucuronidation) of sulfamethoxazole; total renal elimination accounts for ~80-90% of the dose (sulfamethoxazole 30% parent, 40% metabolites; trimethoprim 60-80% parent, remainder as metabolites). Biliary/fecal <5%.
Category D/X
Category C
Antibiotic
Antibiotic
"The serum concentration of Rolapitant can be increased when it is combined with Nitrofurantoin."