Auditory and Visual Hallucinations Associated With Nitrofurantoin Use in an Inpatient Setting: A Case Report

Area of Science:

• Pharmacology
• Geriatric Medicine
• Neuropsychiatry

Background:

• Nitrofurantoin is a widely prescribed antibiotic for urinary tract infections (UTIs).
• Adverse neurological and psychiatric effects associated with antibiotic use are recognized.
• Previous reports suggest a link between antibiotics and acute psychosis.

Observation:

• An 86-year-old immunocompetent female presented with new-onset auditory and visual hallucinations.
• These symptoms emerged on the fifth day of nitrofurantoin therapy for a UTI.
• The patient had no prior history of hallucinations or cognitive impairment.

Findings:

• A comprehensive workup ruled out other potential causes for the hallucinations.
• The clinical presentation strongly suggested nitrofurantoin as the causative agent for the neuropsychiatric effects.
• This represents a unique case of combined auditory and visual hallucinations linked to nitrofurantoin in a geriatric patient.

Implications:

• This case underscores the potential for severe neuropsychiatric side effects from nitrofurantoin, even in immunocompetent individuals.
• Clinicians should maintain a high index of suspicion for drug-induced psychosis when evaluating geriatric patients with new-onset hallucinations.
• Further research may be warranted to elucidate the mechanisms behind nitrofurantoin-induced neuropsychiatric events and identify at-risk populations.