니트로푸란토인
Nitrofurantoin
Synthetic nitrofuran antibacterial
다른 이름: Macrodantin · Macrobid · Furadantin · furadoninum · nitrofurantoinum · Nitrofurantoine
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
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동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Prevention of re-infections with gram-negative organisms | 4 mg/kg | PO | q24h | Long-term | 🌎 NA |
| Recurrent UTI (Conventional dose) | 4 mg/kg | PO | q8h | — | 🌎 NA |
| Recurrent UTI (Prophylactic dose) | 3-4 mg/kg | PO | q24h | — | 🌎 NA |
| Susceptible bacterial urinary tract infections | 4 mg/kg | PO | q6-8h | — | 🌎 NA |
| Susceptible bacterial urinary tract infections | 5 mg/kg | PO | q8h | — | 🌎 NA |
| Susceptible bacterial urinary tract infections | 4.4 mg/kg | PO | q8h | — | 🌎 NA |
| Urinary tract infections (lower UTI only) | 4.4-5 mg/kg | PO | q8h | As directed by culture and sensitivity | 🌍 EU |
- Prevention of re-infections with gram-negative organisms: Give once a day immediately before bedtime after the dog has urinated. Only use after extensive search for underlying cause and after effective treatment of existing UTI.
- Recurrent UTI (Prophylactic dose): Should be given at night after micturition and immediately before bedtime.
- Susceptible bacterial urinary tract infections: Listed as three times daily.
- Urinary tract infections (lower UTI only): For urinary tract infections only. Not for pyelonephritis.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible bacterial urinary tract infections | 5 mg/kg | PO | q8h | — | 🌎 NA |
| Recurrent UTI (Conventional dose) | 4 mg/kg | PO | q8h | — | 🌎 NA |
| Recurrent UTI (Prophylactic dose) | 3-4 mg/kg | PO | q24h | — | 🌎 NA |
| Susceptible bacterial urinary tract infections | 4 mg/kg | PO | q6-8h | — | 🌎 NA |
| Urinary tract infections (lower UTI only) | 4.4-5 mg/kg | PO | q8h | As directed by culture and sensitivity | 🌍 EU |
- Recurrent UTI (Prophylactic dose): Should be given at night after micturition and immediately before bedtime.
- Urinary tract infections (lower UTI only): For urinary tract infections only. Not for pyelonephritis.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Susceptible urinary tract infections | 2.5-4.5 mg/kg | PO | q8h | — | 🌎 NA |
| Susceptible urinary tract infections | 10 mg/kg | PO | q24h | — | 🌎 NA |
- Susceptible urinary tract infections: Listed as three times daily.
- Susceptible urinary tract infections: Listed as daily.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
니트로푸란토인 (Nitrofurantoin)은 주로 요로 방부제/항균제로 사용되는 합성 니트로푸란계 항균제입니다.
- 부위 특이적 효능: 소변으로 빠르게 배설되기 때문에 하부 요로에서는 높은 농도에 도달하지만, 전신 혈류나 조직에서는 치료 농도에 도달하지 않습니다. 따라서 하부 요로 감염(UTI)에는 매우 효과적이지만 전신 감염, 신우신염(신장 감염) 또는 신주위 농양에는 효과가 없습니다.
- 항균 스펙트럼: 대장균(E. coli), 클레브시엘라(Klebsiella), 포도상구균(Staphylococcus), 장구균(Enterococcus)을 포함한 많은 그람 음성균 및 그람 양성균에 활성을 나타냅니다. 슈도모나스(Pseudomonas spp.) 및 대부분의 프로테우스(Proteus) 균주에는 효과가 없다는 점에 유의해야 합니다.
- 임상적 요점: 1차 항생제에 대한 내성이 증가함에 따라, 니트로푸란토인은 특히 내성 대장균이나 장구균에 의해 발생하는 다제내성 하부 요로 감염을 위해 보류되는 경우가 많습니다.
작용 기전
Nitrofurantoin can be bacteriostatic or bactericidal depending on the concentration and organism susceptibility.
- Mechanism: Inside the bacterial cell, nitrofurantoin is reduced by bacterial flavoproteins to highly reactive intermediate compounds.
- Pathway: Reactive intermediates → attack bacterial ribosomal proteins and other macromolecules → inhibit protein synthesis, aerobic energy metabolism (specifically acetyl coenzyme A), DNA synthesis, RNA synthesis, and cell wall synthesis.
- Environmental Factor: It exhibits significantly greater antibacterial activity in acidic environments.
안전성·주의사항
금기사항
- Renal impairment (decreased efficacy and increased risk of systemic toxicity)
- Known hypersensitivity to nitrofurantoin
- Pregnant patients at term (risk of hemolytic anemia in neonates)
- Rats (high risk of neurotoxicity)
- Significant renal impairment (decreased excretion leads to toxic serum levels)
- Pregnancy (mutagenic properties)
- Pyelonephritis
- Systemic infections outside the urinary tract
- Food-producing animals
부작용
- Gastrointestinal disturbances (vomiting, nausea, diarrhea)
- Hepatopathy (can be severe or chronic)
- Myasthenic-like effects (rare, reversible in dogs)
- Infertility in male dogs
- Peripheral neuropathy (rare)
- Hemolytic anemia (rare)
- Pneumonitis (rare)
- Emesis
- Diarrhoea
- Gastrointestinal bleeding
- Hepatotoxicity
- Peripheral neuritis (rare)
- Pulmonary complications (rare)
- Thrombocytopenia (at high doses)
- Anaemia (at high doses)
- Leucopenia (at high doses)
- Prolonged bleeding times (at high doses)
주의
Renal Function Warning: Do not use in patients with compromised renal function. The drug relies on renal excretion to reach the site of infection (the bladder); poor kidney function means the drug won't work for the UTI and will accumulate in the blood, causing toxicity.
- Hepatotoxicity: Can cause drug-induced hepatopathy. Monitor liver enzymes if adverse effects are suspected, especially during long-term prophylactic use.
- Reproductive Warning: May cause infertility in male dogs. Use with caution in breeding animals.
- Lab Interference: May cause false-positive urine glucose results if using cupric-sulfate solutions (e.g., Clinitest). May also cause decreases in blood glucose and increases in serum creatinine, bilirubin, and ALP.
약물 상호작용
Nitrofurantoin may antagonize the antimicrobial activity of fluoroquinolones; concomitant use should be avoided.
May increase the oral bioavailability and absorption of nitrofurantoin.
May inhibit the oral absorption of nitrofurantoin.
May inhibit the renal excretion of nitrofurantoin, potentially increasing systemic toxicity and reducing its effectiveness in the urinary tract.
Delays gastric emptying time and increases absorption/bioavailability of nitrofurantoin
Delays gastric emptying time and increases absorption/bioavailability of nitrofurantoin
Antagonism of antibacterial efficacy
May increase the hyperkalaemic effects of spironolactone
Significantly decreases the antibacterial activity of nitrofurantoin
모니터링
- Clinical efficacy (resolution of UTI symptoms, negative urine cultures)
- Adverse effects (especially GI upset)
- Periodic liver function tests (especially with chronic/prophylactic therapy)
- Resolution of clinical signs of UTI
- Urine culture and sensitivity
- Renal function (BUN, Creatinine)
- Complete Blood Count (CBC) if used long-term or at high doses
- Liver enzymes
약동학
반감기
흡수
Rapidly absorbed from the GI tract. Presence of food enhances absorption. Macrocrystalline forms are absorbed more slowly, resulting in less GI upset and prolonged urine levels.
분포
Therapeutic levels in systemic circulation are not maintained due to rapid elimination. Approximately 20-60% is bound to serum proteins. Crosses the placenta; minimal quantities found in milk.
대사
Some of the drug is metabolized, primarily in the liver.
배설
Rapidly eliminated. Approximately 40-50% is excreted into urine unchanged via both glomerular filtration and tubular secretion. Peak urine levels occur within 30 minutes of dosing.
과다투여
Because the drug is rapidly absorbed and excreted, patients with normal renal function usually require little therapy for mild overdoses.
- Massive Overdose: If ingestion was recent, empty the gut using standard protocols (emesis/gastric lavage).
- Monitoring: Monitor closely for gastrointestinal distress, hepatotoxicity, and neurologic signs. Provide supportive care as needed.
제품
제형
- Oral capsules (macrocrystals)
- Oral capsules (monohydrate/macrocrystals)
- 50 mg tablet
- 100 mg tablet
- 25 mg/5 ml oral suspension
인용의약품
- Nitrofurantoin Macrocrystals Oral Capsules: 25 mg, 50 mg & 100 mg (Macrodantin, generic)
- Nitrofurantoin Monohydrate/Macrocrystals Oral Capsules: 100 mg (Macrobid, generic)
- Nitrofurantoin Oral Suspension: 25 mg/5 mL (5 mg/mL) (Furadantin)
- Nitrofurantoin 50 mg tablets
- Nitrofurantoin 100 mg tablets
- Nitrofurantoin 25 mg/5 ml oral suspension
규제 현황
Banned for use in food-producing animals (Annex IV / Table 2 substance).
Human POM used under the prescribing cascade. Banned in food-producing animals.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store in tight containers at room temperature and protect from light. Do not freeze the oral suspension. Nitrofurantoin will decompose if it comes into contact with metals other than aluminum or stainless steel.
보호자 정보
니트로푸란토인은 방광 감염 치료에 특별히 사용되는 항생제입니다. 소변에 농축되어 세균을 죽이지만 신체의 다른 부위 감염에는 효과가 없습니다.
- 음식과 함께 투여: 이 약은 항상 식사나 간식과 함께 투여하십시오. 이렇게 하면 위장 장애(구토)를 크게 줄이고 신체가 약을 더 잘 흡수하도록 돕습니다.
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- 처방된 약 끝까지 복용하기: 반려동물의 상태가 호전된 것처럼 보이더라도, 감염이 재발하거나 내성이 생기는 것을 방지하기 위해 처방된 항생제를 끝까지 모두 복용해야 합니다.
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