RT Journal Article SR Electronic T1 Long-term nitrofurantoin: analysis of complication awareness, monitoring and pulmonary injury cases JF BJGP Open JO BJGP Open FD Royal College of General Practitioners SP BJGPO.2021.0083 DO 10.3399/BJGPO.2021.0083 A1 Toby Peter Speirs A1 Nicole Tuffin A1 Finlay Mundy-Baird A1 Helena Sakota A1 Sarah Mulholland A1 Michelle Westlake A1 Max Lyon A1 Andrew R Medford A1 Charles Sharp A1 Michael Darby A1 Mahableshwar Albur A1 Francis Keeley A1 Helena Burden A1 Charlie Kenward A1 Elizabeth Jonas A1 Shaney Barratt A1 Huzaifa I Adamali YR 2021 UL http://bjgpopen.org/content/early/2021/08/18/BJGPO.2021.0083.abstract 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.