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Nitrofurantoin

Anti-Infective Agents
CATEGORIES

Anti-Infective Agents, Anti-Infective Agents, Urinary


ALIASES

Furadantin®, Nitrofurantoin Alternova, Macrobid, Macrodantin, Niftran, Nitrofurantoin, Nitrofurantoin (macrocrystals), 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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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.
Measurements in the environment or wastewater are lacking, even internationally. Also environmental degradation data is missing. When selecting the algal test for antibiotics the European Medicines Agency, EMA, recommends test on blue-green algae (cyanobacteria). No information on toxicity on blue-green algae has been found, which means that a calculation of the toxicity becomes uncertain.

Studies have shown that even low concentrations of antibiotics in the environment may contribute to antibiotic resistance and therefore measures should be taken to ensure that as little as possible ends up in our environment.

Comparison with ciprofloxacin and trimethoprim:
Both ciprofloxacin and trimethoprim are included in the Stockholm County Council's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017-2021. Ciprofloxacin and trimethoprim are found in Swedish wastewater treatment plants in concentrations that are likely to select for antibiotic resistance. Risks associated with large emissions of ciprofloxacin to the environment in manufacturing abroad have been detected.

Nitrofurantoin is expected to have low environmental risk for aquatic organisms and low risk of resistance selection in wastewater, although the use would increase significantly.

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.