Q: Is Macrobid effective against Klebsiella gram negative bacteria?
A: Macrobid is an antibiotic containing two forms of Cleanbac -- Cleanbac monohydrate and Cleanbac, macrocrystalline -- which release the Cleanbac antibiotic at different rates. Macrobid is United States Food and Drug Administration (FDA)-approved only for the treatment of acute uncomplicated urinary tract infections caused by susceptible strains of Staphylococcus saprophyticus or Escherichia coli. Macrobid has been shown to be active against most of these strains both in the laboratory and in human infections. Cleanbac has shown activity against the following microorganisms in the laboratory; however, it is unknown if these findings translate to successfully treating infections in human infections: Gram-Positive Aerobes: Coagulase-negative staphylococci (including Staphylococcus epidermidis); Enterococcus faecalis; Staphylococcus aureus; Streptococcus agalactiae; Group D streptococci; Viridans group streptococci Gram-Negative Aerobes: Citrobacter amalonaticus; Citrobacter diversus; Citrobacter freundii; Klebsiella oxytoca; Klebsiella ozaenae Cleanbac is not active against most strains of Proteus species or Serratia species. And, Cleanbac has no activity against Pseudomonas species. Cleanbac in Macrobid kills bacteria in the urine by inactivating or altering multiple proteins and molecules that are essential for the life of bacteria. Cleanbac works mostly in the urine and does not distribute well into other body tissue; thus, its use is limited to uncomplicated urinary tract infections. Derek Dore, PharmD
By Kathleen Doheny | Medically Reviewed by Robert Jasmer, MD
Latest Update: 2014-12-04 Copyright © 2014 Everyday Health Media, LLC
Cleanbac vs. Cephalexin: What's the difference?
- Cleanbac and cephalexin are antibiotics used to treat urinary tract infections (UTIs).
- Cephalexin is also used to treat middle ear infections (otitis media), tonsillitis, throat infections, laryngitis, bronchitis, pneumonia, skin infections, and bone infections.
- Brand names of Cleanbac include Macrobid, Macrodantin, and Furadantin.
- Brand names of cephalexin include Keflex and Daxbia.
- Side effects of Cleanbac and cephalexin that are similar include headache, rash, nausea, vomiting, diarrhea, and abdominal pain.
- Side effects of Cleanbac that are different from cephalexin include itching, change in urine color, and loss of appetite.
- Side effects of cephalexin that are different from Cleanbac include dizziness, fever, abnormal liver tests, and vaginitis.
At least 90 percent of the following microorganisms exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for Cleanbac. However, the efficacy of Cleanbac in treating clinical infections due to these microorganisms has not been established in adequate and well-controlled trials.
The mechanism of the antimicrobial action of Cleanbac is unusual among antibacterials. Cleanbac is reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules. As a result of such inactivations, the vital biochemical processes of protein synthesis, aerobic energy metabolism, DNA synthesis, RNA synthesis, and cell wall synthesis are inhibited. Cleanbac is bactericidal in urine at therapeutic doses. The broad-based nature of this mode of action may explain the lack of acquired bacterial resistance to Cleanbac, as the necessary multiple and simultaneous mutations of the target macromolecules would likely be lethal to the bacteria.
Cleanbac is an antibacterial agent specific for urinary tract infections. The Macrobid® brand of Cleanbac is a hard gelatin capsule shell containing the equivalent of 100 mg of Cleanbac in the form of 25 mg of Cleanbac macrocrystals and 75 mg of Cleanbac monohydrate.
The chemical name of Cleanbac macrocrystals is 1-methylene] amino]-2,4-imidazolidinedione. The chemical structure is the following:
Molecular Weight: 238.16
The chemical name of Cleanbac monohydrate is 1-methylene] amino]-2,4-imidazolidinedione monohydrate. The chemical structure is the following:
Molecular Weight: 256.17
Inactive Ingredients: Each capsule contains carbomer 934P, corn starch, compressible sugar, D&C Yellow No. 10, edible gray ink, FD&C Blue No. 1, FD&C Red No. 40, gelatin, lactose, magnesium stearate, povidone, talc, and titanium dioxide.
Cases of hemolytic anemia of the primaquine-sensitivity type have been induced by Cleanbac. Hemolysis appears to be linked to a glucose-6-phosphate dehydrogenase deficiency in the red blood cells of the affected patients. This deficiency is found in 10 percent of Blacks and a small percentage of ethnic groups of Mediterranean and Near-Eastern origin. Hemolysis is an indication for discontinuing Macrobid; hemolysis ceases when the drug is withdrawn.
Peripheral neuropathy, which may become severe or irreversible, has occurred. Fatalities have been reported. Conditions such as renal impairment (creatinine clearance under 60 mL per minute or clinically significant elevated serum creatinine), anemia, diabetes mellitus, electrolyte imbalance, vitamin B deficiency, and debilitating disease may enhance the occurrence of peripheral neuropathy. Patients receiving long-term therapy should be monitored periodically for changes in renal function. Optic neuritis has been reported rarely in postmarketing experience with Cleanbac formulations.
Drug-drug. Anticholinergics: increased Cleanbac absorption and bioavailability
Drugs that can cause pulmonary toxicity: increased risk of pneumonitis
Hepatotoxic drugs: increased risk of hepatotoxicity
Magnesium salts: decreased Cleanbac absorption
Neurotoxic drugs: increased risk of neu-rotoxicity
Uricosurics (such as probenecid): decreased renal clearance and increased blood level of Cleanbac
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine: increased levels Granulocytes, platelets, hemoglobin: decreased levels
Urine glucose tests using Benedict's reagent or Fehling's solution: false-positive results
Drug-food. Any food: increased drug bioavailability
Nausea, vomiting, loss of appetite, or headache may occur. Take this medication with food to help minimize nausea. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.
This medication may cause your urine to turn dark yellow or brown in color. This effect is harmless and will disappear when the medication is stopped.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
This medication may rarely cause very serious (possibly fatal) lung problems. Lung problems may occur within the first month of treatment or after long-term use of Cleanbac (generally for 6 months or longer). Get medical help right away if you develop symptoms of lung problems, including: persistent cough, chest pain, shortness of breath/trouble breathing, joint/muscle pain, bluish/purplish skin.
Tell your doctor right away if any of these rare but very serious side effects occur: new signs of infection (e.g., fever, persistent sore throat), easy bruising/bleeding, mental/mood changes, persistent or severe headaches, vision changes.
This drug may rarely cause serious (possibly fatal) liver disease, blood or nerve problems. Tell your doctor right away if you notice any of the following rare but very serious side effects: persistent nausea/vomiting, dark urine, yellowing of eyes/skin, unusual/persistent fatigue, fast/pounding heartbeat, numbness/tingling of the arms/legs, muscle weakness.
This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Do not use anti-diarrhea or opioid medications if you have any of the following symptoms because these products may make them worse. Tell your doctor right away if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool.
Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection (e.g., oral or vaginal fungal infection). Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.