Drug-induced haemolysis: another reason to be cautious with nitrofurantoin

Chaitanya Bhatt, Zainab Doleeb, Priya Bapat, Christian Pagnoux
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Abstract

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years. We report the case of a previously healthy woman in her 60s who presented to the emergency department with acute confusion, vomiting and fever. She was recently diagnosed with a urinary tract infection as an outpatient and had completed the fifth day of a 7-day course of treatment with nitrofurantoin. We maintained a wide differential diagnosis including infectious, metabolic, autoimmune and medication-related causes. She developed an acute normocytic anaemia in hospital with a haemoglobin drop from 121 g/L to 89 g/L. Further investigation revealed evidence of haemolysis with an elevated bilirubin, lactate dehydrogenase, reticulocyte count and decreased haptoglobin. She was worked up for both inherited and acquired causes of haemolysis and found to have glucose-6-phosphate dehydrogenase deficiency. Her presentation was thought to be secondary to nitrofurantoin-induced haemolysis and she recovered completely with conservative management through intravenous fluids and discontinuation of nitrofurantoin. Nitrofurantoin is recommended by both the Canadian and American Urological Association as a first-line antibiotic for uncomplicated urinary tract infections (UTIs),1 even though it only exerts bactericidal effects in the urine when reacting with susceptible bacteria at therapeutic doses.2 As a commonly prescribed antibiotic, clinicians should be aware of its broad side effect profile. Nitrofurantoin is frequently associated with nausea, vomiting, diarrhoea and loss of appetite.2 It has also been associated with severe adverse events such as pulmonary toxicity, hepatotoxicity and peripheral neuropathy. Haemolytic anaemia in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency is another possible side effect, which may be easily overlooked, …
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药物引起的溶血:谨慎使用硝基呋喃妥因的另一个原因
DTB 将与 BMJ 病例报告合作,不定期刊登读者可能感兴趣的药物相关病例。这些病例包括近期上市但不良反应知识有限的药物,以及上市多年但反应异常的药物。我们报告了这样一个病例:一名 60 多岁的健康妇女因急性精神错乱、呕吐和发烧到急诊科就诊。她最近在门诊被诊断为尿路感染,并且已经完成了硝基呋喃妥因 7 天疗程的第五天。我们进行了广泛的鉴别诊断,包括感染、代谢、自身免疫和药物相关原因。她在住院期间出现急性正常红细胞性贫血,血红蛋白从 121 克/升降至 89 克/升。进一步检查发现她有溶血症状,胆红素、乳酸脱氢酶、网状细胞计数升高,血红蛋白下降。对她进行了遗传性和获得性溶血病因检查,发现她患有葡萄糖-6-磷酸脱氢酶缺乏症。她的病症被认为是继发于硝基呋喃妥因引起的溶血,通过静脉输液和停用硝基呋喃妥因的保守治疗,她完全康复了。加拿大和美国泌尿外科协会均建议将硝基呋喃妥因作为治疗无并发症尿路感染(UTI)的一线抗生素1,尽管该药只有在治疗剂量下与易感细菌发生反应时才会在尿液中产生杀菌作用2。2 硝基呋喃妥因作为一种常用的处方抗生素,临床医生应注意其广泛的副作用。2 硝基呋喃妥因常伴有恶心、呕吐、腹泻和食欲不振。葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症患者的溶血性贫血是另一种可能出现的副作用,这种副作用可能很容易被忽视, ...
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Drug and Therapeutics Bulletin
Drug and Therapeutics Bulletin Medicine-Pharmacology (medical)
CiteScore
0.80
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发文量
69
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