Macrobid (scientific name nitrofurantoin) is an antibiotic used to treat lower or uncomplicated urinary tract infections in women and also it’s used to prevent UTI.
Join me in this article as I’m going to discuss what happens if your Macrobid regimen doesn’t work for your UTI condition or doesn’t get rid of your urinary tract infection.
Also, we are going to discuss why sometimes Macrobid doesn’t work for your UTI and how to fix that, and also how to make it work in full capacity so you don’t waste the drug.
First off do not panic
If your doctor prescribes Macrobid to your UTI and it doesn’t work there are plenty of other antibiotics that can kill the UTI bacteria other than Macrobid, some of them are specific to some UTI causing bacteria, and others can kill almost every type of bacteria the can cause a UTI like ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole.
If Macrobid doesn’t work for your UTI, switching or adding another antibiotic like fosfomycin or a fluoroquinolone antibiotic like ciprofloxacin or levofloxacin is sufficient and will get rid of the infection.
Worst case scenario (and this happens very rarely) you will need an IV antibiotic like ceftriaxone, amikacin, vancomycin, or maybe meropenem for very severe cases.
Your doctor(s) will decide what’s best for you if god forbids you to reach such a severe UTI level.
In most cases, and likely you are one of them, Macrobid will be enough for you and you won’t need other antibiotics.
Usually, if you are taking Macrobid or any other generic name of nitrofurantoin you will be taking it based on the doctor’s prescription.
I don’t think there are people who would take Macrobid on their own because it’s not very popular like amoxicillin or Keflex and other antibiotics which people (at least in my country) take without a doctor’s consultation every time they feel sick.
If you are taking Macrobid without the doctor’s opinion I highly encourage you to stop doing that immediately and refer to the doctor if you think you have a urinary tract infection.
Taking any antibiotic without a doctor’s prescription is increasing the problem of bacterial resistance worldwide, also antibiotics can sometimes cause side effects.
In most cases, if your doctor prescribes Macrobid (or any nitrofurantoin) for you, then you are most likely a woman and you are having what is called lower urinary tract infection or uncomplicated UTI.
Note: lower UTI and uncomplicated UTI are pretty much (although not exactly) the same as a community-acquired UTI.
If you are a woman and you have an uncomplicated UTI (lower UTI), then Macrobid is most likely is going to work on you and it will rid you of your UTI, you should feel your symptoms are getting better within 2-3 days.
even if your symptoms get better you should continue the whole Macrobid course.
Macrobid is given to UTI cases where other first-line antibiotics have found resistance or difficulty in treating them.
See nowadays first-line antibiotics like ciprofloxacin and trimethoprim (septrin) are facing increased bacterial resistance meaning some UTI cases are not getting treated by them.
On the other hand, Macrobid (nitrofurantoin) has much lower bacterial resistance rates than Cipro and septrin and it’s an old antibiotic discovered in the ’50s and since that time it got very little bacterial resistance cases.
according to the NCBI website, the probability of the E. coli bacteria (the bacteria responsible for about 80% of the UTI cases) to be resistant to nitrofurantoin is 1-2%.
Also, WebMD agrees on that too.
If you are that unlucky to be from that 1-2% then don’t worry, there is an antibiotic called fosfomycin in which also very rare resistance cases have been found and it can be used to treat your UTI.
Read about the efficacy of fosfomycin in treating UTI
ciprofloxacin and levofloxacin and trimethoprim-sulfamethoxazole can also be used for the Macrobid resistant bacteria.
the doctor will decide what’s best for you they can use these antibiotics in conjugation or separately if all of these didn’t work which I don’t think will happen, intravenous antibiotics like amikacin ceftriaxone are also available and they will eradicate the infection completely.
there are two types of UTI one that is called community-acquired UTI responsible for about 80% of the UTI cases around the world which you can get from living your normal daily life in your house, community, work, etc…
the second type is called hospital-acquired UTI which patients get from their contaminated catheters.
to make this short Macrobid can kill almost every type of bacteria that can cause community-acquired UTI including the E. coli, klebsiella pneumoniae, enterobacter species, VRE, and VSE.
it’s safe to say that Macrobid (nitrofurantoin) is effective against all of the community-acquired UTI causing bacteria.
side note: E. coli bacteria is responsible for about 80–85% of the community-acquired UTI cases.
so if you didn’t get your UTI from a hospital do not worry about Macrobid not working for you.
so it’s very unlikely that Macrobid won’t work for you especially if it was prescribed correctly for the suitable conditions that it can treat.
there are some cases in which Macrobid will not work for your UTI and they are if it was prescribed incorrectly or you haven’t taken it as you should.
the best way to take Macrobid
the best way to take Macrobid (nitrofurantoin) for your UTI is to follow your doctor’s prescription accurately, in general, Macrobid (100mg per cap) is best taken one capsule twice daily orally and after meal for 7 days.
other forms of nitrofurantoin could come in 50mg per cap so they are best taken 4 times daily you can ask your pharmacist whether your nitrofurantoin is 50mg or 100mg and also about the dosing.
although it is very hard for a doctor to prescribe Macrobid (nitrofurantoin) incorrectly because it has only 2 or 3 uses in maximum and its roles are very distinguished from other drugs.
if that happens here are some possible scenarios where Macrobid (nitrofurantoin) could be prescribed incorrectly or taken without a prescription, and also what to do about them.
incorrect Macrobid prescribing situations where it can lead to the drug not working for UTI:
1) Macrobid is given to a man’s UTI.
Men’s UTI mostly is a complicated UTI or an upper urinary tract infection in which other antibiotics are preferred over Macrobid like levofloxacin, amikacin, ciprofloxacin.
If you are a man and you are given Macrobid to treat your UTI, wait 2-3 days and if you don’t notice any improvement in your symptoms you should ask your doctor to switch it for you to a suitable antibiotic in the meantime drink a lot of water and some orange juice so that your condition won’t get worse.
here is an article I made about UTI for men it can help you.
2) Macrobid is given to a hospital-acquired UTI
although I highly doubt that this has, is or will happen, I don’t think that Macrobid will even come in the discussion if you or a close one has a hospital-acquired UTI, there are many other suitable antibiotic options for this kind of case.
if this ever happens just switching or maybe adding a more suitable antibiotic will suffice.
antibiotics like ceftriaxone, amikacin, gentamicin, vancomycin, or cefotaxime, mostly the IV antibiotics; but ciprofloxacin and levofloxacin can also help, the doctors will decide what’s best for the patient.
I wrote an article about home remedies that can help in the treatment and also the prevention of UTI.
3) Macrobid is given to an unsusceptible community-acquired UTI
although earlier we said that Macrobid is effective against almost all of the community-acquired UTIs, there may be some cases where the bacteria causing the community-acquired UTI are not susceptible to Macrobid.
keep in mind that the chance of that happening is very very rare so as we said earlier you shouldn’t worry about Macrobid not working for your community-acquired UTI.
it mostly happens with people who have poorly treated their UTIs or with people having recurrent UTIs and similar situations.
so what you will have to do in that situation is to just wait until 2-3 days of taking Macrobid and if you don’t notice any improvement in your condition contact your doctor to switch it for you to another antibiotic or maybe add an antibiotic to Macrobid.
your doctor should aim for an antibiotic that will eradicate the infection completely, aggressive therapy is needed for this situation.
4) Macrobid is given to a UTI caused by another illness like kidney stones or prostate enlargement
in this case, there is a chance of Macrobid actually treating your UTI condition but also there is a chance that it will fail.
the bacteria that cause a UTI in such cases are sometimes not within the range of Macrobid or more resistant to Macrobid.
although I never saw a case like this, you could be having kidney stones and those kidney stones are causing you a UTI but your doctor or your pharmacist could mistakenly think that it’s a normal UTI.
in this case, they will give you Macrobid and there is a high chance that it won’t work for that kind of UTI.
the solution here is to do some laboratory tests may be a urine examination and a sonar test to find if there are any kidney stones in your urinary tract, if you are above 50 years of age you should do a prostate examination.
treating the causative illness will make the UTI very easier to treat a course of good antibiotic will suffice like ciprofloxacin.
5) misdiagnosing
there are many infections and illnesses that can give symptoms very similar to UTI.
although they are very similar to UTI, treating those illnesses and infections will be very different from treating UTI.
I think this is the most common way in which Macrobid or nitrofurantoin won’t be working for your UTI because it’s not a UTI in the first place.
cystitis can almost present the same symptoms as a UTI so misdiagnosing it with UTI is very common, Macrobid will not help you with it.
sexually transmitted diseases like chlamydia can sometimes although to a lesser extent be misdiagnosed with a UTI and also Macrobid won’t be helping you with them.
I have written an article called what can mimic a UTI to help you distinguish between them and a UTI, this can very much help your doctor in making the right diagnosis.
also, check out this helpful article from WebMD
6) Macrobid is given to an elderly UTI
generally, the immune system in elderly people is weaker than it is in younger people, so the antibiotics used to treat UTI in young people are not enough when it comes to an elder person.
elderly UTI is often severe and is characterized by dementia and symptoms like delirium and confusion.
Macrobid is not efficient in treating elderly UTI maybe it can be added in conjugation with other antibiotics but in most cases other more suitable antibiotics are used.
so if it was used with an elder person, there is a great chance that it won’t work very well, other antibiotics should be given in addition or switched with Macrobid.
ways to enhance the performance of Macrobid
do not use Macrobid with antacids especially those that contain aluminum hydroxide
take Macrobid with milk to increase its absorption
protect the box of Macrobid from light and store it at room temperature.
take the full regimen of Macrobid as prescribed by your doctor even if the UTI goes away before finishing the regimen.
elderly people and people with impaired renal function should not take Macrobid.
pregnant women can take Macrobid but not before giving birth.
do not use it for the purpose of preventing a UTI unless told by your doctor, try to avoid long term use as it’s associated with serious side effects.
according to the NHS website Macrobid can turn the color of urine into dark yellow or brown, this is completely normal, continue taking Macrobid, the color will go after you finish taking Macrobid.
how do you know if your UTI is uncomplicated
we said earlier that Macrobid is very effective when it comes to treating the uncomplicated UTI or the lower UTI or community-acquired UTI and that you should expect little to no resistance from these infections to Macrobid.
so how to know if your UTI is of these types, of course, your doctor should tell you but what if you want to make sure or maybe they didn’t tell you?
_ uncomplicated UTI symptoms are not too severe, they consist of frequency and urgency to urinate and also a burning sensation with urination, lower abdominal pain, etc…
_ you should not have fever, chills, nausea or strong fatigue, which means the UTI is becoming complicated
_ uncomplicated UTI pain should be in the lower flank or lower abdominal area not in the upper abdominal area.
_ the color of the urine is darker during an uncomplicated UTI episode but it should not be red or even pink which basically means you are passing blood with your urine and that is a sign of a complicated UTI.
some drugs like azo (phenazopyridine) can turn the color of urine to red and that is completely normal
_ generally, the symptoms of a complicated UTI are much more severe than it’s little sister if you notice any of its symptoms on you or a loved one contact the doctor immediately, more information about complicated UTIs is in this article.
to sum this up
you should not worry if a professional doctor prescribes Macrobid (nitrofurantoin) for you, it will work for your UTI.
even if it didn’t work for your UTI there are many other antibiotics stronger or more suitable to the bacteria you are dealing with.
if you have taken Macrobid by your own discretion or by the advice of a friend then that’s when you should worry it will not work for your UTI.
to know if Macrobid is working for your UTI or not you should wait 2-3 days and if you did not notice any improvement in your symptoms then contact your doctor.
Macrobid mostly works for community-acquired or uncomplicated UTIs while it is not suited for hospital-acquired or any type of complicated UTIs or upper UTIs.
doctors are finding that Macrobid is better than ciprofloxacin or trimethoprim in treating uncomplicated UTIs because it has very much lower bacterial resistance rates than ciprofloxacin and trimethoprim.
thank you and you can check out my website for other UTI helpful articles