There are few new antibiotics on the horizon and those that have been recently approved are mostly for intravenous use, so older ‘forgotten’ drugs are being re-explored for the treatment of cystitis. 6 It is likely that resistance rates have continued to rise since then. 4, 5 One large national survey of urinary isolates from 2015 found resistance rates in Escherichia coli of 43% for ampicillin, 9% for amoxicillin with clavulanic acid, 16% for cefazolin, 22% for trimethoprim, and 7% for ciprofloxacin. Limited Australian data are available for antimicrobial resistance rates in community-onset urinary tract infections. This has resulted in increasing numbers of patients with uncomplicated urinary tract infections requiring hospitalisation for intravenous antibiotics because there are no oral treatment options. Consequently, empiric therapy is more likely to fail. 1 - 3 In Australia, multidrug resistant Gram-negative bacilli are responsible for a rising proportion of community-acquired uncomplicated urinary tract infections. 2007 176(3):319-320.Antimicrobial resistance is increasing worldwide, resulting in infections that are more difficult to treat and associated with higher mortality, morbidity and cost. Acute respiratory failure during pregnancy: a case of nitrofurantoin-induced pneumonitis. Urinary tract infections during pregnancy. The safety of nitrofurantoin during the first trimester of pregnancy: meta-analysis.
Ben David S, Einarson T, Ben David Y, et al. Hemolytic reactions to nitrofurantoin in patients with glucose-6-phosphate dehydrogenase deficiency: theory and practice. General reproduction, perinatal-postnatal, and teratology studies of nitrofurantoin macrocrystals in rats and rabbits. Sulfonamides, nitrofurantoin, and risk of birth defects. American College of Obstetricians and Gynecologists. Neonatal outcomes after gestational exposure to nitrofurantoin. Nordeng H, Lupattelli A, Romøren M, Koren G. Furadantin (nitrofurantoin) oral suspension. Drug experts seem to disagree with nitrofurantoin’s prescribing information, but as always, each patient scenario must be viewed independently, and all risks and benefits must be weighed. This statement was derived from the generally mixed evidence concerning an association between nitrofurantoin and birth defects. However, the American College of Obstetricians and Gynecologists Committee Opinion on sulfonamides, nitrofurantoin, and risk of birth defects state that if other treatment options are not able to be used (eg, cephalosporins, erythromycin), then sulfonamides and nitrofurantoin may be used as first-line agents for the treatment of UTI during the second and third trimesters. In isolation, this study would suggest that nitrofurantoin should be avoided in the last 30 days of pregnancy. While no neonates in the registry were identified as having glucose-6-phosphate dehydrogenase deficiency, there was no difference in the incidence of hemolytic anemia. It is important to note that the difference in incidence of neonatal jaundice did not affect pregnancy outcomes in the study population. This significant difference held up after multivariate analysis that adjusted for prematurity, neonatal sex, year of birth, use of oxytocin to induce labor, neonatal systemic antibiotic treatment, maternal age, parity, and smoking at the end of pregnancy. However, neonates exposed to nitrofurantoin in the last 30 days before delivery had a significantly higher rate of neonatal jaundice requiring treatment compared with neonates exposed to pivmecillinam during the same stage of pregnancy (10.8% and 8.8%, respectively p=0.023). Moreover, the rates of negative pregnancy outcomes such as stillbirth and neonatal mortality, low birth weight, preterm delivery, transfer to NICU, or Apgar score lower than 7 at 5 minutes were no different among the study groups. 
After comparing 1334 mothers who received nitrofurantoin during their pregnancy with 5800 mothers who received pivmecillinam and 130,889 mothers who received no antibiotics for UTIs, the researchers found that the incidence of any malformation-including cardiovascular, atrial septum, or ventricular septum defects-were no different among the groups.
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