Nitrofurantoin is recommended as a first-line antibiotic for the treatment of urinary tract infections (UTIs). However, it is contraindicated in patients with a creatinine clearance (Clcr) less than 60 mL/min. In 2015, the American Geriatrics Society updated the Beers criteria to recommend nitrofurantoin for short-term use in patients with a Clcr greater than or equal to 30 mL/min. It is unknown if nitrofurantoin can be safely and effectively used in a frail patient population with a high incidence of UTIs and frequent use of antibiotics. It is important to have treatment options other than fluoroquinolones and sulfamethoxazole/trimethoprim for patients with recurrent UTIs and frequent antibiotic use to sustain optimal antimicrobial stewardship practices. This study evaluated the safety and efficacy of nitrofurantoin for UTIs in medically complex patients with renal impairment living in a community setting, and it highlights the potential role for pharmacists to encourage antimicrobial stewardship.