Case Number 18 Acute Nitrofurantoin Pneumonia

Mitani, G

doi:10.1177/106002807400800104

Cited by 3 publications

(4 citation statements)

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“…6,14 In contrast, the chronic reaction is generally believed to have a toxic mechanism. 3,7 According to the Naranjo adverse drug reaction probability scale, 2 it is highly probable (score of 10) that our patient experienced an acute pulmonary reaction to nitrofurantoin, with acute chest pain and pressure, nausea and vomiting, substernal burning, hypotension, fever, chills, muscle aches, and weakness. This reaction is well documented in the literature, and a temporal relationship was noted between the start of therapy and the appearance of symptoms, as well as discontinuation of therapy and resolution of symptoms (Figure 1).…”

Section: Discussionmentioning

confidence: 97%

“…The literature contains reports of pulmonary toxicity in patients receiving long-term therapy [3][4][5] as well as acute cases. 3,4,[6][7][8][9][10][11] In addition, the nitrofurantoin package insert warns, in bold type, "Chronic, subacute, or acute pulmonary hypersensitivity reactions may occur with the use of nitrofurantoin." 12 Our patient's case involved both rechallenge with nitrofurantoin and complete clinical data, which is not common in the existing literature.…”

Section: Discussionmentioning

confidence: 99%

“…14 The author of one report asserted that it is not unusual for a patient to have two or three episodes of pulmonary symptoms before a drug reaction is suspected. 7 In addition, involvement of several prescribers may contribute to the difficulty in promptly identifying this reaction. 7 Involvement of several prescribers may have been a contributing cause of the delayed diagnosis with our patient, who was under the care of her primary physician, a urologist who prescribed the nitrofurantoin, and several other physicians during her hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…7 In addition, involvement of several prescribers may contribute to the difficulty in promptly identifying this reaction. 7 Involvement of several prescribers may have been a contributing cause of the delayed diagnosis with our patient, who was under the care of her primary physician, a urologist who prescribed the nitrofurantoin, and several other physicians during her hospital stay. As with other adverse drug reactions, diagnosis of acute pulmonary reaction to nitrofurantoin is generally based on clinical suspicion, ruling out other possible causes, temporal relationships, and other considerations, such as those listed for determining a Naranjo adverse drug reaction probability scale 2 score.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Acute Nitrofurantoin-Induced Pulmonary Toxicity

Williams

Triller

2006

Pharmacotherapy

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Nitrofurantoin may be used for prophylaxis of recurrent urinary tract infections in women; however, this agent has been associated with acute, subacute, and chronic pulmonary adverse reactions. The acute reaction occurs in about 1/5,000 women after their first exposure to the drug. We report the occurrence of two successive, highly probable (by Naranjo score) nitrofurantoin-induced acute pulmonary reactions in the same patient. On day 4 of prophylaxis with nitrofurantoin 100 mg/day (to prevent urinary tract infections), the patient developed intense substernal pain and pressure. On day 8, she experienced intense substernal burning. She went to the emergency department, where she vomited and was hypotensive and febrile. Her chest radiograph showed bilateral infiltrates. The patient was diagnosed with pneumonia and was prescribed levofloxacin; she stopped taking the nitrofurantoin. Her symptoms subsided over the next 3 days. Ten days later, the patient restarted the nitrofurantoin, and she returned to the emergency department after again experiencing sudden intense substernal burning, nausea, vomiting, shivering, and weakness. Nitrofurantoin was discontinued; her symptoms resolved quickly, and prophylaxis with trimethoprim-sulfamethoxazole was begun. After 1 year, the patient had experienced no further pulmonary symptoms or urinary tract infections. Drug toxicity must be considered in patients who develop pulmonary symptoms while taking nitrofurantoin. Symptoms are often misdiagnosed as other ailments, potentially subjecting patients to unnecessary treatments and delaying discontinuation of nitrofurantoin. Patients should be advised to contact a physician if breathing difficulties or unusual symptoms develop while taking nitrofurantoin, as this could result in earlier recognition of this drug reaction.

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Section: Discussionmentioning

confidence: 97%