Key result
A review of 13 sources found various recommendations for monitoring older patients on long-term nitrofurantoin prophylaxis, but none were scientifically tested to detect or prevent adverse reactions.
Why the study?
Are there scientifically tested recommendations for regular monitoring of patients ≥65 years old on long-term nitrofurantoin prophylaxis to prevent or detect adverse reactions?
Are there scientifically tested recommendations for regular monitoring of patients ≥65 years old on long-term nitrofurantoin prophylaxis to prevent or detect adverse reactions?
Current recommendations for monitoring older patients on long-term nitrofurantoin prophylaxis lack long-term scientific validation for detecting or preventing adverse reactions.
Recommendations for monitoring older adults on long-term nitrofurantoin lack validated evidence; leaves open need for prospective trials to test protocols.
INTRODUCTION: We reviewed the current literature for recommendations or guidelines for regular monitoring of patients 65 years old or older on long-term nitrofurantoin prophylaxis to prevent/detect adverse reactions. METHODS: The 2012 Beers criteria recommended avoiding nitrofurantoin for long-term suppression due to potential pulmonary toxicity and the availability of safer alternatives. We performed a literature search on PubMed® for national organizations, textbooks and any report or publication advocating methods of followup to detect and/or prevent long-term nitrofurantoin related adverse reactions. Articles not in English and those related to children or pregnant women were excluded from analysis. RESULTS: A total of 13 sources recommended various methods to improve the safety of patients on long-term nitrofurantoin suppression. Monitoring recommendations were vague, calling for increased scrutiny and education in general in 5 studies or on the part of the physician in 10 and/or the patient in 3. One study from 2008 and one from 2012 recommended biannual chest x-rays, liver function tests and kidney function monitoring but with no supportive prospective data to justify these guidelines. No study documented the role of these preventive guidelines in the early detection of long-term nitrofurantoin related adverse reactions and none addressed the cost-effectiveness of these additional monitoring tests. CONCLUSIONS: While many sources give a variety of recommendations on monitoring an older patient on long-term nitrofurantoin prophylaxis, none appeared to be scientifically tested in the long term to detect adverse reactions or prevent them altogether.
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Rego et al. (2015) conducted a review in Long-term nitrofurantoin prophylaxis (n=13). Regular monitoring was evaluated on Recommendations for monitoring and evidence of effectiveness. A review of 13 sources found various recommendations for monitoring older patients on long-term nitrofurantoin prophylaxis, but none were scientifically tested to detect or prevent adverse reactions.
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