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Nitrofurantoin: friend or foe?

Nicole Kapral1, Rovin Saxena1, Anupam Ashutosh Sule1

  • 1Internal Medicine, St Joseph Mercy Oakland, Pontiac, Michigan, USA.

BMJ Case Reports
|August 18, 2018
PubMed

Insights

Nitrofurantoin can cause acute liver failure, even with short-term use for urinary tract infections. This rare side effect highlights the need for careful patient monitoring during antibiotic treatment.

Area of Science:

  • Pharmacology
  • Hepatology
  • Infectious Diseases

Background:

  • Nitrofurantoin is a primary treatment for uncomplicated cystitis and recurrent urinary tract infections.
  • Drug-induced liver injury (DILI) from nitrofurantoin can manifest acutely or chronically.
  • Acute DILI is rare, occurring in approximately 3 in 1,000,000 cases.

Observation:

  • A 69-year-old male presented with jaundice and elevated liver enzymes after five days of nitrofurantoin for cystitis.
  • The patient was admitted for chronic obstructive pulmonary disease exacerbation.
  • Investigations for infectious, autoimmune, and cholestatic causes of liver injury were negative.

Findings:

  • The patient experienced acute liver failure attributed to short-term nitrofurantoin use.
  • Liver enzymes normalized, and jaundice resolved after drug discontinuation and a 10-day course of methylprednisolone.
  • The exact mechanism of nitrofurantoin-induced hepatotoxicity remains unclear, but an autoimmune process is suspected.

Implications:

  • This case highlights the potential for acute liver failure with short-term nitrofurantoin administration, a condition with limited reported data.
  • Steroids may be a potential treatment modality for nitrofurantoin-induced hepatotoxicity.
  • Diagnosis is challenging and relies on excluding other causes, with drug rechallenge being the only definitive diagnostic method.
Keywords:
contraindications and precautionsgastrointestinal systemliver disease

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