Nitrofurantoin induced pulmonary edema

Q: 23 years old female is admitted to ICU with acute pulmonary edema after 24 hours of initiating nitrofurantoin. Which two points speak against the diagnosis of "Nitrofurantoin induced pulmonary edema"?

Answer: Four decades ago, nitrofurantoin was considered the mainstay of treatment for cystitis amongst women. The rise of quinolones resulted in the disappearance of nitrofurantoin from clinical practice. Since the antibacterial resistance is rising for quinolone, the is a reemergence of interest in nitrofurantoin. This led to an increase in the cases of nitrofurantoin toxicity, particularly pulmonary edema. It can occur acutely as well as in patients who are prescribed chronic therapy.

The patient's age and the symptoms' timeline are the two things that speak against the diagnosis of nitrofurantoin-induced edema. Nitrofurantoin-induced pulmonary edema is more common in patients above 65, particularly in chronic users. It takes about 8-9 days for symptoms to emerge in acute cases.

Treatment is the discontinuation of the drug. Steroids may or may not be helpful.

#pharmacology

#toxicity

#ID

References:

1. Holmberg L, Boman G. Pulmonary reactions to nitrofurantoin. 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966-1976. Eur J Respir Dis 1981; 62:180.

2. Santos JM, Batech M, Pelter MA, Deamer RL. Evaluation of the Risk of Nitrofurantoin Lung Injury and Its Efficacy in Diminished Kidney Function in Older Adults in a Large Integrated Healthcare System: A Matched Cohort Study. J Am Geriatr Soc 2016; 64:798.

3. Kabbara WK, Kordahi MC. Nitrofurantoin-induced pulmonary toxicity: A case report and review of the literature. J Infect Public Health 2015; 8:309.