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Nitrofurantoin

Anti-Infective Agents
CATEGORIES

Anti-Infective Agents, Anti-Infective Agents, Urinary


ALIASES

Furadantin®, Macrobid, Macrodantin, Niftran, Nitrofurantoin, Nitrofurantoin (macrocrystals), Nitrofurantoin Alternova, Nitrofurantoin Oral Suspension, Siraliden, Urantoin, Urolong


SUBSTANCES

nitrofurantoin


ENVIRONMENTAL CONCERN: HIGH
A bacteriostatic or bactericidal agent depending on the concentration and susceptibility of the infecting organism. Nitrofurantoin is active against some gram positive organisms such as S. aureus, S. epidermidis, S. saprophyticus, Enterococcus faecalis, S. agalactiae, group D streptococci, viridians streptococci and Corynebacterium. Its spectrum of activity against gram negative organisms includes E. coli, Enterobacter, Neisseria, Salmonella and Shigella. It may be used as an alternative to trimethoprim/sulfamethoxazole for treating urinary tract infections though it may be less effective at eradicating vaginal bacteria. May also be used in females as prophylaxis against recurrent cystitis related to coitus. Nitrofurantoin is highly stable to the development of bacterial resistance, a property thought to be due to its multiplicity of mechanisms of action.

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IN SCOPE
HIGH

This substance is an antibiotic (also called, anti-bacterial agent). All antibiotics are suspected to cause antibiotic resistance and we should therefore try to limit releasing it to Nature via our wastewater streams.

Some key facts from WHO

  • Antibiotic resistance is one of the biggest threats to global health. food security, and development today
  • Antibiotic resistance can affect anyone, of any age, in any country.
  • Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
  • A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
  • Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.

REFERENCES

  1. European Medicines Agency, EMA: Committee for Medicinal Products for Human Use (CHMP). Guideline on the Environmental Risk Assessment of Medicinal Products for Human Use. 1 June 2006.
  2. Bengtsson-Palme J, Larsson DG. Concentrations of antibiotics predicted to select for resistant bacteria: Proposed limits for environmental regulation. Environ Int. 2016;86:140-9.
  3. Fass.se för vårdpersonal
  4. Larsson DG. Pollution from drug manufacturing: review and perspectives. Philos Trans R Soc Lond B Biol Sci. 2014;369:(1656).
  5. Stockholms läns landsting. Förteckning över miljöbelastande läkemedel inklusive åtgärdsförslag framtagen inom ramen för SLL:s miljöprogram 2017–2021.
  6. IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3. Pharmaceuticals.
  7. Bengtsson-Palme J, Hammarén R, Pal C, Östman M, Björlenius B, Flach CF et al. Elucidating selection processes for antibiotic resistance in sewage treatment plants using metagenomics. Sci Total Environ. 2016;572:697-712.
  8. Gullberg E, Cao S, Berg OG, Ilbäck C, Sandegren L, Hughes D et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 2011;7:e1002158.

SOURCES

  1. Drugbank, The DrugBank database is a unique bioinformatics and cheminformatics resource that combines detailed drug data with comprehensive drug target information.
  2. PubChem, PubChem is the world's largest collection of freely accessible chemical information. Search chemicals by name, molecular formula, structure, and other identifiers
  3. ECHA, The European Chemicals Agency (ECHA) is the driving force among regulatory authorities in implementing the EU's groundbreaking chemicals legislation for the benefit of human health and the environment as well as for innovation and competitiveness.
  4. EMA, The mission of the European Medicines Agency (EMA) is to foster scientific excellence in the evaluation and supervision of medicines, for the benefit of public and animal health in the European Union (EU).
  5. EU watch-list, Commission Implementing Decision (EU) 2018/840 of 5 June 2018 establishing a watch list of substances for Union-wide monitoring in the field of water policy pursuant to Directive 2008/105/EC of the European Parliament.
  6. Umweltbundesamt, Since its founding in 1974, the German Environment Agency (Umweltbundesamt – UBA) has been Germany’s main environmental protection agency.
  7. Naturvårdsverket, A public agency in Sweden that is responsible for environmental issues. The Agency carries out assignments on behalf of the Swedish Government relating to the environment in Sweden, the EU and internationally
  8. Läkemedelsverket, The Swedish Medical Products Agency (MPA) is the Swedish national authority responsible for regulation and surveillance of the development, manufacturing and marketing of drugs and other medicinal products.
  9. FASS, The Swedish environmental classification of pharmaceuticals at www.fass.se has now been running since October 2005. Since then a large amount of environmental information of pharmaceuticals has been published.
  10. Janusinfo, Janusinfo is providing drug information to support healthcare professionals in their everyday work. The website is the electronic means of communication of the Drug Therapeutic Committee and the Health and Medical Care Administration of the Stockholm County Council, Sweden.