Australia - A recent letter to the Medical Journal of Australia has highlighted a case of peripheral neuropathy in association with nitrofurantoin, an antibiotic used for urinary tract infection prophylaxis (1). This is a well known effect of nitrofurantoin but awareness may be declining due to reduced use.

The Australian Adverse Drug Reactions Committee (ADRAC) has received 18 reports of peripheral neuropathy since 1978. While there were no reports received between 1990 and 1997, there have been three in the last 4 years. Most of the reports have involved elderly females. Daily dosages have ranged from 100 mg to 400 mg with a median of 250 mg. The time to onset has ranged from 3 weeks to over 12 months (median: 2-3 months) before the reaction was identified. Only 4 of the 18 patients were documented as having recovered at the time the report was submitted to ADRAC. Peripheral neuropathy can be both severe and irreversible.

Prescribers should take care with the use of nitrofurantoin in the elderly, those with renal impairment and those taking the drug for prolonged periods. Particular attention to the use of the minimum effective dose may reduce the possibility of occurrence of peripheral neuropathy and any suggestive symptoms should trigger cessation of the drug.

Reference:

1. Australian Adverse Drug Reactions Bulletin, Volume 20; Number 3, 2001.

2. Spring, P.J., Sharpe, D.M., Hayes, M.W. Nitrofurantoin and peripheral neuropathy: a forgotten problem? Medical Journal of Australia, 174: 153-154 (2001).