Bacterial drug resistance has become a major concern for urologists in the treatment of urinary tract infection (UTI). One drug which has managed to avoid such resistance problems in its thirty years of use is nitrofurantoin. Nitrofurantoin is effective therapeutically for the treatment of acute lower tract infections, chronic UTI, and for the suppression of catheter-associated bacteria. On a prophylactic basis it is used to sterilize urine before TURP and to prevent chronic reinfection. Its unique mechanism of action, site specificity, achievement of high urinary levels and low serum concentrations, and its effectiveness against both gram-negative and gram-positive bacteria provide many advantages in UTI therapy that many of the newer agents do not. Adverse drug reactions, especially pulmonary toxicity, are extremely rare, and nitrofurantoin maintains an excellent safety profile.