Risks of long-term use of nitrofurantoin for urinary tract prophylaxis in the older patient

PurposeTo review the current literature on reported pulmonary, liver, and nerve adverse reactions (ARs) of long-term Nitrofurantoin (NF) suppression in older patients treated for urinary tract infections (UTIs).Materials and methodsAn extensive literature search was performed on PubMed for the search terms “Nitrofurantoin,” and “Nitrofurantoin and lung, pulmonary, liver, nerve or ARs”. Relevant cited papers were also analyzed. Articles not in English, or related to children, or pregnant women were excluded.ResultsIn 43 articles and other texts meeting the inclusion criteria from 1968 to 2014, rates of long-term NF-related pulmonary ARs compared to total NF prescriptions differed worldwide, but remained extremely small at 0.001% (USA) and 0.001% for pulmonary and hepatic ARs (France). Among all NF ARs, rates of pulmonary ARs differed across the literature from 2% (UK), 3% (Holland), 5% (Sweden), to 7% (Australia). Nerve ARs were reported as .0007% and liver ARs as .0003% of total prescriptionsConclusionsPulmonary, nerve, or liver ARs resulting from long-term NF prophylaxis in older patients treated for UTIs are potentially serious but extremely rare, and should not deter from the cautious use of NF in this population.