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Nitrofurantoin pulmonary toxicity: neglected threat
Emilia Hardak1, Gidon Berger, Norberto Krivoy
1Division of Pulmonary Medicine, Rambam Healthcare Campus, Haifa, Israel.
Current Drug Safety
|June 19, 2009
Summary
Nitrofurantoin can cause lung toxicity, even at low doses for urinary tract infections. Early diagnosis and treatment, including stopping the drug or using steroids, often lead to recovery.
Area of Science:
- Pulmonology
- Pharmacology
- Infectious Diseases
Background:
- Nitrofurantoin is commonly prescribed for urinary tract infections (UTIs).
- Pulmonary toxicity is an uncommon but serious adverse effect of nitrofurantoin.
- Recurrent UTIs necessitate long-term antibiotic prophylaxis.
Purpose of the Study:
- To report on cases of nitrofurantoin-induced lung toxicity.
- To highlight the clinical presentation and outcomes of patients with nitrofurantoin lung toxicity.
- To emphasize the importance of considering nitrofurantoin as a cause of pulmonary symptoms.
Main Methods:
- Case series of ten patients diagnosed with nitrofurantoin lung toxicity.
- Review of clinical data including dosage, duration of therapy, symptoms, and treatment outcomes.
- Analysis of diagnostic criteria and therapeutic interventions.
Main Results:
- Ten patients developed lung toxicity while on nitrofurantoin 50 mg/day for UTI prevention.
- Symptoms persisted for 3-36 months in six patients before diagnosis.
- Nine out of ten patients recovered fully after drug discontinuation or corticosteroid therapy; one had irreversible lung injury.
Conclusions:
- Nitrofurantoin can cause severe pulmonary toxicity, necessitating a high index of suspicion in patients with unexplained respiratory symptoms.
- Prompt recognition and management, including drug withdrawal and/or steroid use, are crucial for favorable outcomes.
- Alternative antibiotics with a better risk-benefit profile should be considered for long-term UTI prophylaxis.
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