The American Geriatrics Society 2015 Beers Criteria Update Expert Panel has revised its recommendation to avoid use of nitrofurantoin in renal impairment from patients with a creatinine clearance (Clcr) of less than 60 mL/min to those with a Clcr of less than 30 mL/min, based on two retrospective studies that identified the safety and efficacy of nitrofurantoin in this population. This change in recommendation, along with increasing resistance to both sulfamethoxazole/trimethoprim and fluoroquinolones, gave rise to the advantages of nitrofurantoin and may reflect a surge in prescribing among the elderly. The purpose of the manuscript is to provide readers with a brief review of updated evidence to confidently treat older patients with nitrofurantoin.