macrobid for UTI

Macrobid For UTI Treatment: Pros And Cons

Since 1953 doctors have been successfully using Macrobid for UTI treatment and prevention in adults, children, and pregnant women (not for late pregnancy). Macrobid, Macrodantin, and Furadantin are the brand names of nitrofurantoin in the US.

Good news that there is no known link between this medication and the development of resistant organisms.

Therefore Macrobid for UTI is a great candidate for the treatment of infections caused by multidrug-resistant bacteria. It works best against UTIs caused by E. coli in the early stages and is not that effective against Klebsiella.

However, Nitrofurantoin is not effective for kidney infection treatment because of extremely poor tissue penetration and low blood levels.

A lesser risk to develop an antibiotic-resistant bacteria

When you take a pill your small intestines quickly absorb nitrofurantoin, 75% of the dose is quickly metabolized by the liver, and 25% of the dose is excreted in the urine.

The antibiotic enters the bacterial cells and damages the genetic material (DNA) of the offending bacteria, affects respiration, certain metabolic processes, and other macromolecules within the bacterial cell and eventually leads to the death of the bacteria.

This means that the bacteria cannot reproduce and repair themselves. Since the mechanism of action is unique and complex it is harder for the bacteria to develop resistance.

Minor side-effects

How soon will nitrofurantoin (Macrobid) work?

  • I felt better within an hour. You should definitely feel better within the first 8-12 hours. However, remember to finish all pills even if you no longer have any symptoms
  • Check out these tips when treating UTI with antibiotics. 

Top three concerns of the patients on Treato, when taking this drug are:

  • Nausea (most reported)
  • Diarrhea
  • Allergies.

I did not have any of the above symptoms and most patients tolerate this antibiotic well.

Minimal effect on your gut’s microbiome

Have you heard that antibiotics kill good and bad gut bacteria? This is, of course, a generalization, a pretty broad statement. Your body has over 3000 types of beneficial bacteria residing in various organs, skin, and membranes.

The unique composition of your good and bad bacteria called “microbiota” or “microbiome”. However, the field of study that focuses on researching how your microbiota composition affects your health is relatively new.

One of the recent clinical studies looked at how nitrofurantoin affects human intestinal microbiota (this did not include vaginal microbiota).

While the study had several limitations early findings demonstrated that a 100 mg dose of nitrofurantoin daily has minimal impact on the aerobic intestinal microbiota.

In fact, nitrofurantoin had an effect of reducing the proportion of Clostridium, some members of which are pathogenic, and increasing Faecalibacterium, considered to have numerous beneficial effects for health through protection against pathogen invasion, modulation of immune system and reduction of cancer progression

It is relatively safe for UTI prevention

In 2014 a clinical study tested nitrofurantoin alongside with D-Mannose (read: What’s D-Mannose powder and how it works) for long-term UTI prevention effectiveness.

A group of 308 female patients with a history of recurrent UTI and no other significant health issues was randomly allocated to three groups after completing antibiotic treatment of acute cystitis.

The first group was taking 2 g of D-mannose powder in 200 ml of water daily for 6 months, the second group received 50 mg Macrobid for UTI prevention daily, and the third did not receive anything to prevent infection from recurring.

As a result, the patients in the D-Mannose group and nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients who were receiving no preventive treatment.

Patients in both groups did not have any significant side effects when taking D-Mannose and nitrofurantoin during this 6 month period.

Concerns with long-term use

Although relatively rare, nitrofurantoin is one of the commonest causes of drug-induced pulmonary disease, which can be very serious and even life-threatening.

It is important to make sure that if you or your loved ones are taking nitrofurantoin (Macrobid) for UTI prevention your physician monitors patient’s lung function regularly.

If you have noticed any problems with lung function, talk to your physician to discontinue nitrofurantoin. Therefore, especially if you are taking this antibiotic for a prolonged period of time to prevent UTIs, pay attention to the following symptoms:

  • Ongoing shortness of breath
  • Fever
  • Chills
  • A cough
  • Recurrent chest infections
  • Chest pain
  • A headache
  • Back pain

In some cases, especially with prolonged usage of nitrofurantoin, severe and irreversible health issues could happen such as peripheral neuropathy. Please read comments below of women who suffer from serious debilitating side-effects associated with prolonged usage of nitro.

Read next:


  1. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.
  2. Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections.
  3. Collateral damage from oral ciprofloxacin versus nitrofurantoin in outpatients with urinary tract infections: a culture-free analysis of gut microbiota.

12 thoughts on “Macrobid For UTI Treatment: Pros And Cons”

  1. Philomena Vanek

    I am so confused by so many different antibiotics for Bladder Infections. I keep getting bladder infections and first I was prescribed Macrobid. Then cipro. Now cephalexin. I don’t know why. My bacteria they fine in my urine is E-Coli. Why does my doctor keep changing antibiotics? Which antibiotic is the best for killing the E-Coli bacteria? I am very healthy and take two cranberry capsules daily, drink a lot of water and take a daily probiotic. So confused why I keep getting E-Coli in my urine!!!

    1. Anastasia Visotsky

      Hi there, yes: they are trying different antibiotics because of bacteria becoming resistant to one type, that’s why the doctors are trying to “keep it interesting” for your E.coli :)) The best would be the one that your bacteria are still sensitive to, and this is what a urine culture test would indicate. Cranberry capsules do nothing unless this is Ellura or Theracran. Here are 26 main reasons why you keep getting your UTIs. Keep educating yourself or find a good doc who could explain 🙂 Best wishes,

  2. Thank you for your comprehensive and useful site. I have suffered UTI’s now for 4 decades. For at least a decade I was taking Cipro, and then was switched to Macrobid. I was taking Macrobid (Nitrofurantoin ) prophylactically, and it completely destroyed my body. This drug is a known neurotoxin, and a known cause of peripheral neuropathy. I didn’t know what was making me so sick at the time, and it took 3 neurologists to figure it out. As the symptoms were coming on, I was also having UTI’s and treating with this drug. I have widespread peripheral neuropathy ( including burning mouth syndrome), erythromelalgia, and autonomic neuropathy. I have been bed bound and in suicidal levels of pain for 4 years, with too many symptoms to list here. The pain is recalcitrant to any treatment ( including Fentanyl), and my feet and face are red and on fire. I developed tachycardia, profuse sweating, inability to regulate my temperature, and more. I feel like my bones are being crushed, and like I am being slashed with knives. Please warn your readers. This drug is NOT safe. P.S. I just learned yesterday that a dear friend was just diagnosed with pulmonary fibrosis. She has a prognosis of 2 years. She was also taking Nitrofurantoin.

    1. Anastasia Visotsky

      Oh my, Kathy, thank you so much for sharing! It sounds horrific and I’m so sorry about these devasting side-effects you are battling with. I’ll add another warning to the post. It is well-known that this antibiotic is not great for long-term treatment, especially elderly who can develop only flu-like symptoms and go for way too long misdiagnosed but your story is especially chilling. I appreciate you taking the time to share. I hope you can find a way to ease these symptoms. Best wishes,

  3. Margaret Carrico

    I have a uti. I took the Macrobid for 10 days as prescribed but the uti has returned. Now I have been given Cipro which I have read has a lot of side effects. I am a bit afraid to take it. What can I do?

  4. I have had a uti that recurs after apparently clearing. I have taken a dose of levoflaxicin and it cleared for a week but has now come back. I have now been told to take nitrofurantoin. Is this OK?

    1. Anastasia Visotsky

      Hi Mije, if your physician prescribed it, then you should take it. It is a better antibiotic for an uncomplicated UTI than levofloxacin. Since your infections tend to come back regularly, check out this post about chronic UTI.
      Best wishes,

  5. I am a male in my mid 60s. I have developed Urethral strictures following transurethral resection of the prostate. … (Urethral stricture is the most common late complication of transurethral prostatectomy (TURP)).
    I now have to self catheterise once a week. Recently I get UTI three days after self catheterisation and have to use nitorfuratorine.
    I have now been told to take ciprofloxacin 250 mg an hour before I self catheterise which I will be starting this week.
    I have just had my D Mannose powder delivered today. How best should i use it? Any advise would be really appreciated.


      1. Hi,
        I have dealt with UTI issues since I was a child and I am now 57 years old. I just took a 7 day dose of Macrobid because of a UTI. Things seemed to have cleared up. However, today is the 3rd day since the last dose and I woke up with a severe bladder infection. Blood, blood clots and typical pressure, pain and other associated with UTI. I spoke to my Dr. and he said to go on another 7 day dose of Macrobid to see if it clears up. Then we are going to be discussing whether I want to go on it 1x a day forever. He said he has had women on it for years and they have done fine with it. I’m a little nervous taking something like this once a day forever. However, I am so tired (literally) of getting these UTI’s. They wipe me out and I have to take time off of work. Can you please tell me how safe it truly is if I go on it once a day? Thanks for your time.

        1. Anastasia Visotsky

          Hi Jeni, you can see some comments front the folks that used. Some tolerate it fine, others complain about respiratory issues (this side-effect could be quite dangerous and should be immediately assessed by your physician). All and all, I’m not a big fan of long-term antibiotic suppression therapy especially if you are otherwise healthy but for many, this is the only answer. I don’t know your story and what you have already tried, but you can join the conversation here, in our closed FB group:

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