Liver Disease Reported in Three Nitrofurantoin Patients

A new study has linked the use of the antibiotic nitrofurantoin with autoimmune hepatitis, a type of liver injury. <"">Nitrofurantoin, which is primarily used in the treatment and prevention of urinary tract infections, is sold under the brand names Furadantin, <"">Macrobid, Macrodantin, Nitrofur Mac, Nitro Macro, Nifty-SR, Martifur-MR and Urantoin.

According to a case study in the Journal of Medical Case Reports, three women (aged 65, 42 and 74 years old) developed autoimmune hepatitis after treatment with nitrofurantoin. All were receiving long-term nitrofurantoin to prevent recurrent urinary tract infections.

Two of the patients presented with jaundice, and one required a prolonged hospital admission for liver failure. In all three patients nitrofurantoin was withdrawn, and long-term immunosuppressive therapy with prednisolone and azathioprine or mycophenolate was given. Fortunately, the patients responded well, with liver biochemistry returning to normal within a few months.

The authors of the report pointed out that although nitrofurantoin rarely causes autoimmune hepatitis, this antimicrobial is increasingly used as long-term prophylaxis against recurrent urinary tract infection. They cautioned general practitioners and urologists who prescribe long-term nitrofurantoin therapy to be aware of this adverse effect.

Autoimmune hepatitis is a disease in which the body’s immune system attacks liver cells. This immune response causes inflammation of the liver, also called hepatitis. Autoimmune hepatitis is usually quite serious and, if not treated, gets worse over time. Autoimmune hepatitis is typically chronic, meaning it can last for years, and can lead to cirrhosis—scarring and hardening—of the liver. Eventually, liver failure can result. About 70 percent of those with autoimmune hepatitis are female.

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