antibioticsbooks

122 PART 2 Antibacterial Drugs
Spectrum
Good: E. coli, Staphylococcus saprophyticus
Moderate: Citrobacter, Klebsiella, Proteus, enterococci,
Pseudomonas (fosfomycin), Serratia
(fosfomycin)
Poor: Acinetobacter
Adverse Effects
Gastrointestinal: Nausea and vomiting are occasionally
reported. Taking the drugs with food
may decrease these effects.
Pulmonary: Nitrofurantoin can cause very rare
but serious pulmonary toxicity of two forms.
First is an acute pneumonitis manifesting
as cough, fever, and dyspnea. This form typically
resolves soon after drug discontinuation.
A chronic pulmonary fibrosis can occur, most
commonly with prolonged nitrofurantoin therapy;
recovery of lung function is limited after
drug discontinuation.
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Important Facts
• It bears repeating: nitrofurantoin and fosfomycin
are ineffective for infections outside of the
lower urinary tract in the formulations available
in the United States (in some countries,
IV fosfomycin is available that can be used to
treat nonurinary tract infections). The drugs
require high concentrations for antimicrobial
activity, and these are reached only where
they concentrate in the urine. Note this also
means that in patients who have significant
renal dysfunction (e.g., a creatinine clearance