Nitrofurantoin Pulmonary Toxicity: A Brief Review

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. 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. Treatment includes discontinuing the medication. Although the role of corticosteroids has not been well described, patients with respiratory symptoms or hypoxemia may benefit from a trial of corticosteroid therapy.

Nitrofurantoin-Induced Pulmonary Reaction Involving Respiratory Symptoms: Case Report

“…1,4 Both acute and chronic forms of nitrofurantoin-induced pulmonary injury have been reported. The estimated incidence of the acute reaction is less than 1%, 1 and those affected are typically relatively younger women (age range 40 to 50 years). 5 Acute pulmonary reactions occur within 1 month of initiating nitrofurantoin therapy, and about 8% of cases present in the first 8 or 9 days.…”

“…5 Acute pulmonary reactions occur within 1 month of initiating nitrofurantoin therapy, and about 8% of cases present in the first 8 or 9 days. 1 Acute reactions may recur more rapidly after repeated courses of therapy with this drug. 1 The clinical presentation of nitrofurantoin-induced pulmonary injury is variable, making diagnosis a challenge.…”

“…1 Acute reactions may recur more rapidly after repeated courses of therapy with this drug. 1 The clinical presentation of nitrofurantoin-induced pulmonary injury is variable, making diagnosis a challenge. The acute presentation is characterized by fever, maculopapular rash, arthralgia, and fatigue, in addition to dry cough, chest pain, and dyspnea.…”

“…Peripheral eosinophilia is also common. 1 Chronic reactions are reportedly 10 to 20 times less frequent than acute reactions, and they tend to affect elderly patients. 5 Chronic pulmonary reaction is characterized by progressive dry cough and dyspnea over weeks to years and often occurs in patients who have been taking nitrofurantoin for 6 months or longer.…”

“…Several cases and various clinical manifestations of pulmonary reactions to nitrofurantoin have been described in the literature. 1 Early recognition of such reactions may prevent disability and death. 2 This article describes a patient with an acute pulmonary reaction, specifically bronchiolitis obliterans organizing pneumonia (BOOP), which occurred after exposure to nitrofurantoin.…”