Edit concept Question Editor Create issue ticket

Nitrofurantoin Toxicity


Presentation

  • Case Presentation: A 92‐year‐old woman with a medical history of recurrent urinary tract infections (UTIs) presented with progressive dyspnea, a dry cough, and low‐grade fevers for 6 weeks.[shmabstracts.com]
  • Nitrofurantoin pulmonary toxicity can present as acute, subacute, or chronic respiratory disease. Common manifestations are dry cough, chest pain, dyspnea, and hypoxemia. Skin rash, arthralgia, and abnormal transaminases are occasionally present.[eurekaselect.com]
  • Patient B, an 81-year old women presented at the emergency department with symptoms of dyspnoea, fever, chest pain on inspiration and painful urination.[ntvg.nl]
  • The acute hypersensitivity reaction often presents with fever, dyspnoea and cough. There is a short (mean 9-days) lag between drug exposure and evolution of respiratory symptoms.[academic.oup.com]
  • All had a history of chronic cystitis and presented with chronic NL.[thorax.bmj.com]
Hypoxemia
  • Although the role of corticosteroids has not been well described, patients with respiratory symptoms or hypoxemia may benefit from a trial of corticosteroid therapy.[eurekaselect.com]
  • Common manifestations are dry cough, chest pain, dyspnea, and hypoxemia. Elderly women are particularly susceptible. Chest imaging shows patchy infiltrates and fibrosis.[shmabstracts.com]
Constitutional Symptom
  • Acute presentation is common and is characterized by constitutional symptoms including fever, rash, arthralgia, and fatigue. Common pulmonary symptoms are dry cough, chest pain, and dyspnea.[shmabstracts.com]
Low Fever
  • Subacute Presents 1 to 6 months after starting Nitrofurantoin treatment, with a dry cough, shortness of breath, low fever and cyanosis.[microbiologynutsandbolts.co.uk]
Dry Cough
  • Common symptoms include dry cough, dyspnea, low‐grade fever, and cyanosis.[shmabstracts.com]
  • Common manifestations are dry cough, chest pain, dyspnea, and hypoxemia. Skin rash, arthralgia, and abnormal transaminases are occasionally present. Chest imaging shows patchy infiltrates and fibrosis.[eurekaselect.com]
  • The syndrome should be considered in patients with fever, dyspnoea, dry cough, leucocytosis typically with eosinophilia and a bilateral interstitial pattern on the chest X-ray after starting nitrofurantoin.[ntvg.nl]
  • Subacute Presents 1 to 6 months after starting Nitrofurantoin treatment, with a dry cough, shortness of breath, low fever and cyanosis.[microbiologynutsandbolts.co.uk]
  • She said that over the previous 2 days she’d had a fever, dry cough, and some difficulty breathing. Her past medical history was significant for asthma, diabetes, hypertension, and osteoarthritis.[mdedge.com]
Rales
  • Relevant clinical findings included a respiratory rate of 28/minute, oxygen saturation of 88% on room air, and bilateral inspiratory rales in the lungs. A chest X‐ray and a CT scan showed extensive diffuse bilateral interstitial lung disease.[shmabstracts.com]
  • […] some cases Clinical Fever (usually present) Dyspnea (usually present) Cough (66% of cases) Bronchospasm (see Obstructive Lung Disease ): may occur in the absence of parenchymal or pleural manifestations in some cases Pleuritic Chest Pain (33% of cases) Rales[mdnxs.com]
Vascular Disease

Workup

Liver Biopsy
  • Prolonged elevation of liver enzyme concentrations together with the presence of increased antibody titers (anti-smooth muscle antibody, antinuclear antibody) was suggestive of chronic hepatitis, a diagnosis corroborated by liver biopsy findings.[ncbi.nlm.nih.gov]
  • A liver biopsy was consistent with drug-induced hepatitis. Hepatic adverse reactions were not observed during clinical trials of this medicine.[tga.gov.au]

Treatment

  • The case studies are not intended as a guide to treatment injury cover. Send your feedback to: TI.info@acc.co.nz How ACC can help your patients following treatment injury Many patients may not require assistance following their treatment injury.[wellsaid.co.nz]
  • Abstract: Nitrofurantoin is an antimicrobial agent that is commonly used for the treatment of recurrent urinary tract infection. Nitrofurantoin pulmonary toxicity can present as acute, subacute, or chronic respiratory disease.[eurekaselect.com]
  • Abstract Nitrofurantoin is an antibiotic commonly used for prophylaxis and treatment of urinary tract infections. Pulmonary and hepatic toxicity are rare side effects of this agent.[ncbi.nlm.nih.gov]
  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • It has a very valued place in the treatment of urinary infections, not least in light of its efficacy against ESBL coliforms.[academic.oup.com]

Prognosis

  • The prognosis is excellent if the condition is recognized early and nitrofurantoin exposure is discontinuated.[ntvg.nl]
  • The prognosis is good if the condition is recognized early, and nitrofurantoin exposure is stopped; however, rare fatalities have been reported.[shmabstracts.com]
  • Drug-induced autoimmune hepatitis: clinical characteristics and prognosis. Hepatology. 2010;51:2040–8. PubMed CrossRef Google Scholar 5. Triantafyllou K, Vlachogiannakos J, Ladas SD.[link.springer.com]
  • Nodule or Mass ) May appear as nodular infiltrates Acute Lung Injury-ARDS (see Acute Lung Injury-ARDS ) Other Adverse Effects Risk of Hemolysis in Patient with G6PD Deficiency (see Glucose-6-Phosphate Dehydrogenase Deficiency and Hemolytic Anemia ) Prognosis[mdnxs.com]

Etiology

  • Bronchoalveolar lavage (BAL) and a transbronchial lung biopsy were negative for infectious and neoplastic etiologies. An echocardiogram showed normal ventricular and valvular functions.[shmabstracts.com]
  • […] despite peripheral eosinophilia) Chronic Nitrofurantoin Toxicity : mimics idiopathic pulmonary fibrosis Adverse Effects Pulmonary Adverse Effects Acute Nitrofurantoin Toxicity (see Drug-Induced Pulmonary Eosinophilia, Pneumonia, Interstitial Lung Disease-Etiology[mdnxs.com]
  • Pathology Etiology Chemotherapy agents These can give several patterns of disease which include 1,5 : interstitial fibrosis : typically NSIP 5 pattern hypersensitivity pneumonitis pattern adult respiratory distress syndrome / diffuse alveolar damage pattern[radiopaedia.org]
  • Viral infection (most commonly herpes simplex virus) is the likely etiology. Most patients recover, even without treatment, although about one in five is left with permanent facial disfigurement or pain.[sanfordguide.com]

Epidemiology

  • Epidemiology One of the most common drug-induced pulmonary diseases Toxicity occurs in Physiology Acute Nitrofurantoin Toxicity : unclear mechanism (studies have shown prolonged lymhocyte transformation factor and migration inhibition factor production[mdnxs.com]
  • Selenium and lung cancer: a quantitative analysis of heterogeneity in the current epidemiological literature. Cancer Epidemiol Biomarkers Prev. 2004;13(5):771-778. (PubMed) 29. Yoshizawa K, Willett WC, Morris SJ, et al.[lpi.oregonstate.edu]
Sex distribution
Age distribution

Prevention

  • Abstract 5-Nitrofuran derivatives change the inner mitochondrial membrane permeability as indicated by the transmembrane potential, the rate of spontaneous K efflux and the basal respiratory rate: (a) at low concentrations nitrofurantoin prevents the[unboundmedicine.com]
  • Nitrofurantoin lung toxicity was diagnosed among ten patients receiving 50 mg/day to prevent recurrent urinary tract infection. In six patients a symptomatic period of 3-36 months preceded the diagnosis.[ingentaconnect.com]
  • Q: For several years I have been taking nitrofurantoin 100 mg to prevent recurring bladder and urinary tract infections (UTIs).[aarp.org]
  • Initially she had been treated with several courses of Nitrofurantoin for UTIs before being prescribed 50mg of Nitrofurantoin daily for three months as a prophylactic treatment to prevent UTI.[wellsaid.co.nz]
  • SELECT: the Selenium and Vitamin E Cancer Prevention Trial: rationale and design. Prostate Cancer Prostatic Dis. 2000;3(3):145-151. (PubMed) 41. Clark LC, Marshall JR.[lpi.oregonstate.edu]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!