Regular Monitoring of Older Women on Long-term Nitrofurantoin Prophylaxis-What Does it Mean Practically?

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.