Interstitial pneumonitis secondary to long-term nitrofurantoin use with improved clinical course secondary to corticosteroids

Abstract

Nitrofurantoin is a frequently used antibiotic for treatment and prophylaxis of urinary tract infections in both the inpatient and outpatient settings. However, there have been adverse effects associated with a prolonged course. A notable adverse event reported in the literature is acute lung toxicity. Traditional treatment modalities include cessation of the drug. After this, lung injury often resolves within weeks. Glucocorticoids are an adjunctive therapy that has been used but has not been definitively demonstrated to decrease recovery time or improve other outcomes. Although it is believed that resolution can occur solely with drug cessation there have been individual reports of steroids resulting in rapid improvement. We present two cases of patients who developed interstitial pneumonitis secondary to prolonged nitrofurantoin usage that resolved or improved with combined drug cessation and systemic corticosteroid administration.