Pulmonary fibrosis following long-term nitrofurantoin therapy
Abstract:
Three patients who developed pulmonary fibrosis following prolonged treatment with nitrofurantoin for chronic urinary tract infections are presented. They had received the drug for 3--4 years; all gave histories of 2--3 years of progressive shortness of breath and an unproductive cough. On examination, all 3 patients had bilateral crackles and 1 had finger clubbing. Chest radiographs showed bilateral shadowing and lung function tests a restrictive defect with reduced gas transfer. Lung biopsies showed extensive fibrosis in 2 patients and advanced honeycomb formation in 1. The response to steroid therapy in 2 patients was excellent, with resolution of symptoms, clearing of the chest radiographs and improvement in lung function. It is proposed that nitrofurantoin has no place in the long-term treatment of chronic urinary tract infections and that its use in acute infections should be questioned.
Insights
Prolonged nitrofurantoin use for chronic urinary tract infections can cause pulmonary fibrosis. Doctors should reconsider long-term nitrofurantoin prescriptions due to these severe lung injury risks.
Area of Science:
- Pulmonology
- Pharmacology
- Infectious Diseases
Background:
- Nitrofurantoin is a common antibiotic for urinary tract infections (UTIs).
- Long-term use of nitrofurantoin has been associated with various adverse effects.
- The potential for nitrofurantoin-induced pulmonary fibrosis requires further investigation.
Observation:
- Three patients developed pulmonary fibrosis after 3-4 years of nitrofurantoin treatment for chronic UTIs.
- Patients presented with progressive shortness of breath, unproductive cough, bilateral crackles, and in one case, finger clubbing.
- Chest imaging revealed bilateral shadowing, and pulmonary function tests showed a restrictive defect with reduced gas transfer.
Findings:
- Lung biopsies confirmed extensive pulmonary fibrosis and honeycomb formation.
- Two patients showed excellent response to steroid therapy, with symptom resolution and improved lung function.
- These cases highlight a severe adverse pulmonary reaction to nitrofurantoin.
Implications:
- Nitrofurantoin is not recommended for long-term management of chronic UTIs.
- The use of nitrofurantoin, even for acute infections, warrants careful consideration.
- Clinicians should be vigilant for pulmonary toxicity in patients on nitrofurantoin therapy.
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