Blujepa vs. Macrobid: Comparing These UTI Antibiotics Side by Side

A urinary tract infection (UTI) can quickly turn your day upside down. The constant urge to pee, the burning, and the discomfort — it’s a frustrating experience that most people want relief from as soon as possible.

The good news is that most UTIs are highly treatable with antibiotics. But not all antibiotics work the same way, and some may be more effective than others, especially with rising antibiotic resistance rates.

Blujepa (gepotidacin) and Macrobid (nitrofurantoin monohydrate / macrocrystals) are two antibiotics a healthcare professional might consider prescribing you. They both treat uncomplicated UTIs, but they work differently. One may be a better fit depending on your symptoms, medical history, and past infections.

Here, we’ll cover seven ways that Blujepa and Macrobid compare, including effectiveness, side effects, and product availability.

1. Blujepa and Macrobid work differently

Macrobid is a UTI antibiotic that’s been around for years. It’s a mainstay treatment that concentrates in the urine and damages proteins that bacteria need to survive. This helps stop an infection where it starts.

Blujepa works in a different way. It belongs to a new class of antibiotics called triazaacenaphthylenes. It works by blocking two key enzymes (proteins) that bacteria need to copy their DNA. Without access to these enzymes, the bacteria can’t replicate and are killed off. This is a different way of fighting UTIs compared with older antibiotics.

Because Blujepa uses a newer mechanism, it may be especially useful in treating UTIs that don’t respond well to other antibiotics. What's more, Blujepa is FDA approved to treat urinary or genital gonorrhea in certain people ages 12 years and older.

2. Blujepa may be more effective for antibiotic-resistant UTIs

Blujepa and Macrobid are both considered effective options for treating UTIs. But an increasingly common challenge in treating UTIs is antibiotic resistance.

In clinical trials, especially the EAGLE-2 and EAGLE-3 studies, Blujepa showed positive results against specific bacteria strains that didn’t respond well to other antibiotics, including some that Macrobid may not fully treat. For people who’ve had multiple UTIs or an infection that didn’t respond to treatment, Blujepa could be a helpful option.

EXPERT PICKS: WHAT TO READ NEXT

• Assessing your options: Here’s a physician-backed summary of some of the best antibiotics for treating a urinary tract infection (UTI).

• Did you receive a prescription for Blujepa (gepotidacin)? Pharmacists provide tips to get the most out of your medication.

• Two formulations of nitrofurantoin: Macrobid and Macrodantin are two versions of the same medication. Read on for a breakdown of how they differ.

3. More people are eligible to take Macrobid for UTIs

Blujepa was FDA approved in March 2025 to treat uncomplicated UTIs in women and girls ages 12 and older who weigh at least 88 lbs (40 kg). It’s the first new oral antibiotic to be approved for UTIs in nearly 30 years.

Macrobid is also meant only for UTIs in women and girls. But some versions of the medication can be given to infants as young as 1 month old. There’s no body-weight restriction.

What’s more, Macrobid may be prescribed for UTI prevention, especially in people who experience frequent UTIs.

Good to know: When Blujepa is prescribed to treat gonorrhea (instead of UTIs), there's no gender or sex restriction.

4. Blujepa may be taken for fewer days, while Macrobid comes in more formulations

Blujepa is usually taken as two 750 mg tablets twice a day for 5 days for UTIs. That’s a short, fixed course designed to clear an infection quickly and effectively.

Macrobid is more flexible in how it’s prescribed, and its active ingredient comes in multiple dosage forms. Here’s a summary.

Your prescriber will help you choose the best antibiotic based on your age, your kidney function, and the nature of your infection.

5. Blujepa and Macrobid have similar side effects overall

Blujepa and Macrobid commonly cause similar side effects, mostly related to the digestive system. Shared Blujepa side effects and Macrobid side effects include:

• Nausea

• Diarrhea

• Headache

• Dizziness

• Abdominal discomfort

Taking either medication with food can help reduce stomach-related symptoms. For most people, these issues are mild and go away once the antibiotic course is finished.

That said, there are some important differences to keep in mind.

Blujepa may cause diarrhea more frequently than Macrobid. It can also lead to neurological symptoms, such as headache and dizziness, and Blujepa has some different risks. These include rare issues such as heart rhythm changes and cholinergic effects, like muscle spasms or increased saliva.

Macrobid has a longer track record and a well-understood safety profile. While it doesn’t typically cause heart side effects, it can lead to rare but serious problems, especially with long-term use or in people with kidney disease. These include lung damage, liver damage, and peripheral neuropathy (nerve damage).

6. Blujepa tends to cause more interactions than Macrobid

Blujepa and Macrobid can both interact with other medications. This is why your healthcare team should carefully review what you’re taking before prescribing either one.

That said, Macrobid generally has less interactions than Blujepa. Most of Blujepa’s interactions occur because of how it interacts with a liver enzyme (protein) that breaks it down. Some interactions are also possible because Blujepa can rarely affect your heartbeat, among other reasons.

This list isn’t all inclusive. Your prescriber and pharmacist will look at your medication list to make sure nothing interacts with your prescription. They’ll tell you which interactions to avoid and which ones require only a dose adjustment. Make sure they’re aware of everything you’re taking — prescription medications, over-the-counter products, and dietary supplements.

7. Only Macrobid is available as a generic

Macrobid is widely available as a generic medication. This helps keep costs down and makes it more likely to be covered by insurance. If you’re paying out of pocket, the generic version is also easier to afford, especially if you use a GoodRx coupon.

Blujepa is a brand-name-only product because it’s a newer medication. This could make it trickier to access, especially if your insurance won’t cover it right away.

Frequently asked questions

Why trust our experts?

Written by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Our editorial standards

Meet our experts