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Acute pulmonary toxicity to nitrofurantoin
1Department of Emergency Medicine, University of Cincinnati, OH 45267-0769.
Abstract:
Nitrofurantoin is a widely prescribed antibiotic used for the treatment of urinary tract infections. In some patients it can produce an acute pulmonary reaction ranging from mild dyspnea to noncardiogenic pulmonary edema. Symptoms include fever, dyspnea, chills, cough, and chest pain. Physical examination generally reveals an acutely ill, extremely apprehensive patient in varying degrees of respiratory distress. Fever is usually present and there is an increase in heart rate and respiratory rate. Cyanosis, rales, and a maculopapular rash are common findings. Laboratory studies typically demonstrate a leukocytosis with eosinophilia, varying degrees of hypoxia and hypocapnia, and a mild to moderate elevation of the erythrocyte sedimentation rate. The chest x-ray study may be normal but more often demonstrates bilateral lower lobe interstitial infiltrates frequently accompanied by pleural effusions. Treatment in the majority of cases requires only stopping the drug, but steroids, bronchodilators, or antihistamines may be used in selected cases. Once the diagnosis is made and the drug withdrawn, prognosis for full recovery is excellent.
Insights
Nitrofurantoin can cause acute pulmonary reactions in some patients, presenting with symptoms like fever and cough. Discontinuing the antibiotic typically leads to an excellent recovery from these nitrofurantoin-induced lung injuries.
Area of Science:
- Pulmonary Medicine
- Pharmacology
- Infectious Diseases
Background:
- Nitrofurantoin is a common antibiotic for urinary tract infections.
- Acute pulmonary reactions are a known, albeit uncommon, side effect.
- These reactions can range from mild to severe respiratory distress.
Purpose of the Study:
- To describe the clinical presentation, diagnostic findings, and management of nitrofurantoin-induced pulmonary toxicity.
- To highlight the importance of recognizing this adverse drug reaction.
Main Methods:
- Review of clinical cases presenting with pulmonary symptoms after nitrofurantoin use.
- Analysis of patient symptoms, physical examination findings, laboratory results, and imaging studies.
- Evaluation of treatment responses after drug withdrawal and supportive care.
Main Results:
- Patients exhibit fever, dyspnea, cough, chest pain, and respiratory distress.
- Physical exam may show cyanosis, rales, and rash.
- Lab results often include leukocytosis with eosinophilia and hypoxia.
- Chest X-rays frequently reveal interstitial infiltrates and pleural effusions.
Conclusions:
- Nitrofurantoin-induced pulmonary reaction is a significant adverse effect.
- Prompt diagnosis and drug withdrawal are crucial for recovery.
- Prognosis is generally excellent once the offending agent is removed.