Evaluation of the role of clinical pharmacists in nitrofurantoin stewardship at a long-term care facility

Document Type


Date of Publication


Publication Title


First Page


Last Page



2010 American College of Clinical Pharmacy Annual Meeting


Austin, TX


Purpose: Nitrofurantoin is frequently used in long-term care facilities (LTCF) to treat urinary tract infections (UTIs) due to low rates of bacterial resistance. However, nitrofurantoin is contraindicated for use in patients with a creatinine clearance less than 60 ml/min due to concerns of subtherapeutic concentrations in the urine, as well as possible gastrointestinal , allergic, pulmonary, hepatic, neurological and hematological reactions. Addition of a clinical pharmacist to an interdisciplinary quality assurance (QA) team may improve the appropriate use of nitrofurantoin for UTIs in a LTCF. The objective of this study was to evaluate use of nitrofurantoin for UTIs in a LTCF before and after clinical pharmacist intervention based on documented creatinine clearance.

Methods: A retrospective review of infection QA data from skilled nursing and assisted living residents was conducted to determine nitrofurantoin prescribing patterns for UTIs from September 2007 to December 2008. A clinical pharmacist joined the QA team and provided recommendations regarding appropriate nitrofurantoin use in April 2008 using calculated creatinine clearance values based on Cockroft-Gault. Data from September 2007 to April 2008 were compared to data from May to December 2008 to determine if a change in prescribing patterns resulted from clinical pharmacist involvement in QA.

Results: A total of 99 UTIs occurred from September 2007 to December 2008 (52 before and 47 after clinical pharmacist intervention) in patients with a documented creatinine clearance less than 60 ml/min. Nitrofurantoin was used in 52% of UTIs prior to clinical pharmacist intervention. After clinical pharmacist education on nitrofurantoin contraindications and adverse effects, nitrofurantoin use dropped to 36% (p<0.01).

Conclusion: The contribution of a clinical pharmacist to QA can greatly reduce the inappropriate use of nitrofurantoin in long-term care facilities.