Three days into nitrofurantoin therapy for a pediatric urinary tract infection, the child develops yellow-brown urine. What is the most appropriate advice?

• A. The urine color change is harmless; continue therapy
• B. Seek emergency care
• C. Stop therapy
• D. Switch to another antibiotic

Answer: (C)

New yellow-brown urine in a child taking nitrofurantoin raises concern for possible liver involvement. While nitrofurantoin can cause harmless urine discoloration in some people, yellow or dark urine can reflect bilirubin buildup from drug-induced liver injury or hypersensitivity. Because liver toxicity can progress, the safest and most appropriate step is to stop the medication and seek medical evaluation to check liver function and reassess the UTI treatment. If additional signs such as jaundice, abdominal pain, or malaise appear, seek urgent care.