The hidden dangers of long-term Nitrofurantoin use

Nitrofurantoin is a commonly prescribed antibiotic for urinary tract infections (UTIs), particularly in women with recurrent infections. While effective, its long-term use carries significant risks—especially when not accompanied by appropriate clinical monitoring.

At Freeths, we are increasingly seeing cases where patients suffer serious harm due to prolonged nitrofurantoin prescriptions without the necessary oversight from their treating doctors.

Understanding the Risks

The Medicines and Healthcare products Regulatory Agency (MHRA) has issued clear guidance on the potential for pulmonary and hepatic adverse reactions associated with nitrofurantoin¹. These risks are particularly pronounced in patients on long-term therapy—defined as three months or more.

Pulmonary Toxicity

Pulmonary reactions can occur acutely, sub-acutely, or chronically. Symptoms may include:

• Persistent cough
• Shortness of breath
• Chest pain
• Fever and chills

In chronic cases, irreversible lung damage can occur if the drug is not discontinued promptly. Alarmingly, these symptoms are often misattributed to other conditions, delaying diagnosis and increasing the risk of permanent injury².

Hepatic Injury

Hepatic complications range from cholestatic jaundice to chronic active hepatitis and even hepatic necrosis. These conditions may develop insidiously, with subtle biochemical changes preceding overt symptoms such as:

• Jaundice
• Fatigue
• Abdominal pain
• Dark urine or pale stools

Without regular liver function tests, these signs can be missed until significant damage has occurred¹.

The Role of Monitoring

Despite the known risks, a 2021 study found that current UK guidelines lack specificity regarding the type and frequency of monitoring required for patients on long-term nitrofurantoin³. This ambiguity can lead to inconsistent practices among healthcare providers.

The MHRA advises that patients on extended courses should undergo periodic liver and lung function tests, and be educated on the warning signs of toxicity. Unfortunately, in many clinical negligence cases we review, these safeguards have not been implemented.

Medical Negligence and Duty of Care

• GPs and prescribing clinicians have a duty to:
  Assess the appropriateness of long-term nitrofurantoin use
• Inform patients of potential risks
• Arrange regular monitoring
• Act promptly on any signs of adverse reactions

Failure to do so may constitute a breach of duty, particularly if harm results from avoidable delays in diagnosis or treatment. 

Mrs Dodds: A Patient’s Story

Mrs Dodds developed pulmonary fibrosis after long term prophylactic prescription of nitrofurantoin without adequate warnings of the risk of long-term use or sufficient monitoring by her GPs. Mrs Dodds has been left with reduced lung function and requires at home oxygen. 

Mrs Dodds was never warned that there was a risk of serious pulmonary injury and was not told to seek medical review if she developed any respiratory symptoms.  

Shockingly Mrs Dodds was not offered a medication review over the 5-year period and she was not monitored by her GPs or offered regular blood tests to check her liver function. 

As a result of the poor treatment she received, Mrs Dodds life expectancy is reduced and her whole world has been turned upside down, she is unable to be as independent and active as she once was and her ability to look after herself has been affected. 

Mrs Dodds feels let down and upset that if simple steps had been taken by her GPs, she could have avoided developing such debilitating symptoms. 

Freeths are helping Mrs Dodds bring a claim for compensation to make sure that she has everything in place to deal with the long term effects of her injuries.

 *please note that Mrs Dodds name has been changed in the interests of maintaining her privacy.