Recurrent acute nitrofurantoin-induced pulmonary toxicity
Ellen M Williams1, Darren M Triller
1Pharmacy Practice Department, Albany College of Pharmacy, NY 12208, USA.
Pharmacotherapy
|May 25, 2006
Summary
Nitrofurantoin can cause acute pulmonary reactions, even with short-term use for urinary tract infection prophylaxis. This case highlights the importance of considering drug toxicity when pulmonary symptoms arise.
Area of Science:
- Pharmacology
- Pulmonary Medicine
- Infectious Disease
Background:
- Nitrofurantoin is a common antibiotic for preventing recurrent urinary tract infections (UTIs) in women.
- However, nitrofurantoin is associated with various pulmonary adverse reactions, including acute, subacute, and chronic forms.
- Acute pulmonary reactions are rare, occurring in approximately 1 in 5,000 women after initial exposure.
Observation:
- This report details a patient experiencing two distinct, highly probable nitrofurantoin-induced acute pulmonary reactions.
- Initial symptoms included substernal pain and pressure, followed by burning, vomiting, hypotension, and fever.
- Chest radiography revealed bilateral infiltrates, initially misdiagnosed as pneumonia.
Findings:
- The patient's symptoms resolved upon discontinuation of nitrofurantoin.
- Upon restarting nitrofurantoin, the patient experienced a recurrence of similar severe symptoms, confirming drug toxicity.
- Alternative prophylaxis with trimethoprim-sulfamethoxazole was successful without recurrence of pulmonary issues.
Implications:
- Clinicians must consider nitrofurantoin drug toxicity in patients presenting with pulmonary symptoms.
- Misdiagnosis can lead to unnecessary treatments and delayed recognition of adverse drug reactions.
- Educating patients about potential nitrofurantoin side effects is crucial for early detection and management.
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