Long-term nitrofurantoin: 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*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review


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.

Original languageEnglish
JournalBritish Journal of General Practice Open
Early online date18 Aug 2021
Publication statusE-pub ahead of print - 18 Aug 2021

Bibliographical note

Copyright © 2021, The Authors.


  • Nitrofurantoin
  • General Practice
  • Urology
  • Drug-Related Side Effects and Adverse Reactions
  • Prescription Drug Monitoring Programs


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