Why is nitrofurantoin not effective in pyelonephritis? is there even sort of a chance of it clearing pyelonephritis or is it completely useless?

Antibiotic advantage: Some antibiotics are just 'better' than others- like most things in life. So unfortunately, as an infectious diseases doctor - I just don't 'trust' nitrofurantoin to do the job - when I know that there are other medications that just work better. I might use nitrofurantoin for a simple UTI, but that's often as a last resort when I have burned up other options. An ID doc can help with expert advice