Skip to main content

Main menu

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • Outreach
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
    • Top 10 Research Articles of the Year
  • SPECIAL ISSUES
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
  • CONFERENCE
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Alerts

Search

  • Advanced search
Intended for Healthcare Professionals
BJGP Open
  • RCGP
    • British Journal of General Practice
    • BJGP for RCGP members
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
BJGP Open
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • LATEST ARTICLES
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • RESOURCES
    • About BJGP Open
    • BJGP Open Accessibility Statement
    • Editorial Board
    • Editorial Fellowships
    • Audio Abstracts
    • eLetters
    • Alerts
    • Outreach
    • BJGP Life
    • Research into Publication Science
    • Advertising
    • Contact
    • Top 10 Research Articles of the Year
  • SPECIAL ISSUES
    • Special issue: Telehealth
    • Special issue: Race and Racism in Primary Care
    • Special issue: COVID-19 and Primary Care
    • Past research calls
  • CONFERENCE
Research

Long-term nitrofurantoin: an analysis of complication awareness, monitoring, and pulmonary injury cases

Toby Peter Speirs, Nicole Tuffin, Finlay Mundy-Baird, Helena Sakota, Sarah Mulholland, Michelle Westlake, Max Lyon, Andrew R Medford, Charles Sharp, Michael Darby, Mahableshwar Albur, Francis Keeley, Helena Burden, Charlie Kenward, Elizabeth Jonas, Shaney Barratt and Huzaifa I Adamali
BJGP Open 2021; 5 (6): BJGPO.2021.0083. DOI: https://doi.org/10.3399/BJGPO.2021.0083
Toby Peter Speirs
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nicole Tuffin
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Finlay Mundy-Baird
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Helena Sakota
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sarah Mulholland
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michelle Westlake
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Max Lyon
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrew R Medford
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charles Sharp
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Darby
2 Department of Radiology, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mahableshwar Albur
3 Department of Microbiology and Infectious Disease, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Mahableshwar Albur
Francis Keeley
4 Department of Urology, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Helena Burden
4 Department of Urology, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charlie Kenward
5 NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elizabeth Jonas
5 NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, United Kingdom
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shaney Barratt
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Huzaifa I Adamali
1 Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Huzaifa I Adamali
  • For correspondence: Huzaifa.Adamali@nbt.nhs.uk
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading
Submit a Response to This Article
Compose eLetter

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com. PLEASE NOTE: your email address will be published.
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

  • RE: Long-term nitrofurantoin – an ongoing safety problem
    Will Howe, Ronan Sheehan, Marco Motta and Mike Wilcock
    Published on: 15 September 2021
  • Published on: (15 September 2021)
    Page navigation anchor for RE: Long-term nitrofurantoin – an ongoing safety problem
    RE: Long-term nitrofurantoin – an ongoing safety problem
    • Will Howe, GP, Lostwithiel Surgery, Cornwall
    • Other Contributors:
      • Ronan Sheehan, Clinical Pharmacist
      • Marco Motta, Pharmacist
      • Mike Wilcock, Pharmacist

    Dear Sir
    We note with interest the research undertaken by Speirs et al identifying a lack of awareness amongst prescribers of serious adverse effects that can occur with long-term nitrofurantoin and the need for more robust monitoring guidelines. As a result of discussions on the potential safety risk of long-term nitrofurantoin and known medico-legal implications,(1,2) we examined the monitoring schedule for nitrofurantoin across a convenience sample of ten practices in two of our primary care networks.

    The computer records of patients that had a record of being prescribed nitrofurantoin (15 or more tablets) were searched over one month in early 2021. From a total registered population of approximately 86,000 patients, we identified 41 patients (35 female) who had received a prescription for prophylactic nitrofurantoin. Thirty-two (78%) of this cohort were aged over 65 years.

    In only 8 (20%) instances was there any evidence in the GP records of a discussion with the patient about possible adverse effects. Liver function had been monitored in 22 (54%) patients within 6 months, whilst a respiratory review had occurred for only 5 (12%) patients, though such a review had been triggered by suspicion of a newly presenting pulmonary complication.

    Nitrofurantoin is commonly used for the treatment and prophylaxis of recurrent urinary tract infections (UTIs), and typically any such prescription is commenced by a GP, though such a decision may also be made...

    Show More

    Dear Sir
    We note with interest the research undertaken by Speirs et al identifying a lack of awareness amongst prescribers of serious adverse effects that can occur with long-term nitrofurantoin and the need for more robust monitoring guidelines. As a result of discussions on the potential safety risk of long-term nitrofurantoin and known medico-legal implications,(1,2) we examined the monitoring schedule for nitrofurantoin across a convenience sample of ten practices in two of our primary care networks.

    The computer records of patients that had a record of being prescribed nitrofurantoin (15 or more tablets) were searched over one month in early 2021. From a total registered population of approximately 86,000 patients, we identified 41 patients (35 female) who had received a prescription for prophylactic nitrofurantoin. Thirty-two (78%) of this cohort were aged over 65 years.

    In only 8 (20%) instances was there any evidence in the GP records of a discussion with the patient about possible adverse effects. Liver function had been monitored in 22 (54%) patients within 6 months, whilst a respiratory review had occurred for only 5 (12%) patients, though such a review had been triggered by suspicion of a newly presenting pulmonary complication.

    Nitrofurantoin is commonly used for the treatment and prophylaxis of recurrent urinary tract infections (UTIs), and typically any such prescription is commenced by a GP, though such a decision may also be made following advice from a urology specialist. Standard prescribing advice is that at commencement of prophylaxis there should be discussion with the patient of the risks of long-term antibiotics including resistance and possible adverse effects, and monitoring (liver function and for signs of pulmonary adverse effects, especially in the elderly) is advised for long-term therapy.(3) Our small study, albeit with no follow up of patient outcomes, points to some deficiencies in following this advice.

    We echo the call by Speirs et al for augmentation of current guidelines with a model monitoring plan.

    Yours sincerely

    Will Howe, GP, Lostwithiel Surgery, Cornwall
    Ronan Sheehan, Clinical Pharmacist, Three Harbours and Bosvena Health PCN, Cornwall
    Marco Motta, Pharmacist, NHS Kernow CCG Medicines Optimisation Team, Cornwall
    Mike Wilcock, Pharmacist, Royal Cornwall Hospitals NHS Trust, Cornwall

    References
    1. https://www.medicalprotection.org/uk/articles/complications-of-nitrofura...
    2. https://www.medicalprotection.org/uk/articles/nitrofurantoin-complicatio...
    3. https://cks.nice.org.uk/topics/urinary-tract-infection-lower-women/manag...

    Show Less
    Competing Interests: None declared.
Back to top
Previous ArticleNext Article

In this issue

BJGP Open
Vol. 5, Issue 6
January 2021
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Email Article

Thank you for recommending BJGP Open.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Long-term nitrofurantoin: an analysis of complication awareness, monitoring, and pulmonary injury cases
(Your Name) has forwarded a page to you from BJGP Open
(Your Name) thought you would like to see this page from BJGP Open.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Long-term nitrofurantoin: an analysis of complication awareness, monitoring, and pulmonary injury cases
Toby Peter Speirs, Nicole Tuffin, Finlay Mundy-Baird, Helena Sakota, Sarah Mulholland, Michelle Westlake, Max Lyon, Andrew R Medford, Charles Sharp, Michael Darby, Mahableshwar Albur, Francis Keeley, Helena Burden, Charlie Kenward, Elizabeth Jonas, Shaney Barratt, Huzaifa I Adamali
BJGP Open 2021; 5 (6): BJGPO.2021.0083. DOI: 10.3399/BJGPO.2021.0083

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Long-term nitrofurantoin: an analysis of complication awareness, monitoring, and pulmonary injury cases
Toby Peter Speirs, Nicole Tuffin, Finlay Mundy-Baird, Helena Sakota, Sarah Mulholland, Michelle Westlake, Max Lyon, Andrew R Medford, Charles Sharp, Michael Darby, Mahableshwar Albur, Francis Keeley, Helena Burden, Charlie Kenward, Elizabeth Jonas, Shaney Barratt, Huzaifa I Adamali
BJGP Open 2021; 5 (6): BJGPO.2021.0083. DOI: 10.3399/BJGPO.2021.0083
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Abstract
    • How this fits in
    • Introduction
    • Method
    • Results
    • Discussion
    • Notes
    • References
  • Figures & Data
  • Info
  • eLetters
  • PDF

Keywords

  • nitrofurantoin
  • general practice
  • urology
  • drug-related side effects and adverse reactions
  • prescription drug monitoring programs

More in this TOC Section

  • Translating primary care to telehealth: analysis of in-person consultations on diabetes and cardiovascular disease
  • Primary care physicians’ perceptions of social determinants of health recommendations: a qualitative study
  • Ethnic minority GP trainees at risk for underperformance assessments: a quantitative cohort study
Show more Research

Related Articles

Cited By...

Intended for Healthcare Professionals

@BJGPOpen's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Latest articles
  • Authors & reviewers
  • Accessibility statement

RCGP

  • British Journal of General Practice
  • BJGP for RCGP members
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP Open
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP Open: research
  • Writing for BJGP Open: practice & policy
  • BJGP Open editorial process & policies
  • BJGP Open ethical guidelines
  • Peer review for BJGP Open

CUSTOMER SERVICES

  • Advertising
  • Open access licence

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Open Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: bjgpopen@rcgp.org.uk

BJGP Open is an editorially-independent publication of the Royal College of General Practitioners

© 2023 BJGP Open

Online ISSN: 2398-3795