PT  - JOURNAL ARTICLE
AU  - Toby Peter Speirs
AU  - Nicole Tuffin
AU  - Finlay Mundy-Baird
AU  - Helena Sakota
AU  - Sarah Mulholland
AU  - Michelle Westlake
AU  - Max Lyon
AU  - Andrew R Medford
AU  - Charles Sharp
AU  - Michael Darby
AU  - Mahableshwar Albur
AU  - Francis Keeley
AU  - Helena Burden
AU  - Charlie Kenward
AU  - Elizabeth Jonas
AU  - Shaney Barratt
AU  - Huzaifa I Adamali
TI  - Long-term nitrofurantoin: analysis of complication awareness, monitoring and pulmonary injury cases
AID  - 10.3399/BJGPO.2021.0083
DP  - 2021 Aug 17
TA  - BJGP Open
PG  - BJGPO.2021.0083
4099  - http://bjgpopen.org/content/early/2021/08/18/BJGPO.2021.0083.short
4100  - http://bjgpopen.org/content/early/2021/08/18/BJGPO.2021.0083.full
AB  - Background Long-term nitrofurantoin (NF) treatment can result in pulmonary and hepatic injury. Current guidelines do not outline the type or frequency of monitoring required for detection of these injuries.Aims To assess (1) awareness of NF complications among prescribers, (2) monitoring practice and (3) to describe the pulmonary sequelae of NF-related complications.Methods (1) Electronic questionnaire to prescribers, interrogating prescribing/monitoring practices and awareness of complications; (2) Case-note review (June-July 2020) of NF monitoring among general practitioners (GPs) in our local clinical commissioning group; (3) Case review of patients diagnosed with nitrofurantoin-induced interstitial lung disease (NFILD) at our interstitial lung disease (ILD) centre (2014-2020).Results 125 prescribers of long-term NF responded to the questionnaire (82% GPs; 12% urologists). Many were unaware of the potential for liver (42%) and lung (28%) complications. 41% and 53% never monitored for these, respectively. Only 53% of urologists believed themselves responsible for arranging monitoring, whilst nearly all GPs believed this to be the prescriber’s responsibility (94%). One third of all respondents considered current British National Formulary (BNF) guidelines “not at all sufficient/clear”, with mean clarity scoring of 2.2/5. Amongst NFILD patients (n=46), NF had been prescribed most often (70%) for treatment of recurrent UTI and 59% (n=27) were prescribed for >6 months. Upon withdrawal of the medication 61% displayed resolution (completely/minimal fibrosis), whilst 16% of patients had progressive lung fibrosis.Conclusion NF can cause marked or irreversible lung complications and there is currently a shortfall in awareness and monitoring. Existing monitoring guidelines should be augmented.