title: How Common Are Pulmonary and Hepatic Adverse Effects in Older Adults Prescribed Nitrofurantoin?
abstract: OBJECTIVE
  To determine the frequency of serious pulmonary and hepatic adverse events (AEs) in persons aged 65 and older prescribed nitrofurantoin.
  
  
  METHODS
  Retrospective electronic health record (EHR) audit of nitrofurantoin prescriptions and associated AEs.
  
  
  METHODS
  Urban academic medical center.
  
  
  METHODS
  All inpatients and outpatients aged 65 and older prescribed nitrofurantoin from January 1, 2010, to December 31, 2014.
  
  
  METHODS
  The number of nitrofurantoin prescriptions and pulmonary and hepatic AEs associated with nitrofurantoin use was acquired by data extraction from EHRs.
  
  
  RESULTS
  Of 3,400 individuals aged 65 and older prescribed nitrofurantoin during the study period, 641 were identified as possibly having one of five targeted symptoms or disease complications (pulmonary and hepatic) associated with nitrofurantoin. After a detailed chart audit, 89% were deemed to have no adverse reaction, 7% had a minor side effect or allergy, and 3.9% met criteria for suspicion of a nitrofurantoin-induced AE, five of whom were rated as being highly suspicious for nitrofurantoin toxicity; four of the five were identified with pulmonary toxicity and one with hepatotoxicity. Four of five of these individuals used nitrofurantoin chronically.
  
  
  CONCLUSIONS
  Nitrofurantoin was prescribed for 3,400 individuals aged 65 and older during the 5-year study period. Serious side effects appeared to be uncommon, but chronic use appeared to be at greater risk.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Karin
authors.initials: K
authors.lastname: Claussen
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Edward
authors.initials: E
authors.lastname: Stocks
authors.affiliation: Office of Heath Systems Affairs., Dallas, Texas.
authors.forename: Deepa
authors.initials: D
authors.lastname: Bhat
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jason
authors.initials: J
authors.lastname: Fish
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Rubin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000892:Anti-Infective Agents, Urinary / Q000009:adverse effects* / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury; D064420:Drug-Related Side Effects and Adverse Reactions; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008171:Lung Diseases / Q000139:chemically induced*; D008297:Male; D009582:Nitrofurantoin / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies
chemical_list: D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin
keywords: Beers criteria; adverse drug events; hepatotoxicity; nitrofurantoin; pulmonary toxicity