{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:30:35Z","timestamp":1791739835119,"version":"4.3.4"},"reference-count":53,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T00:00:00Z","timestamp":1746748800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>Nitrofurantoin, a commonly prescribed antibiotic for urinary tract infections, has been associated with rare but potentially serious pulmonary toxicity, which can present in acute, subacute, or chronic forms. Acute toxicity typically manifests in the form of hypersensitivity pneumonitis, which is characterized by fever, dyspnea, and eosinophilia, often resolving rapidly after drug discontinuation. However, chronic toxicity can lead to interstitial lung disease with progressive fibrosis, causing significant and sometimes irreversible pulmonary impairment. The pathophysiology of nitrofurantoin-induced lung injury is thought to involve oxidative stress, immune-mediated mechanisms, and direct cytotoxic effects; however, the exact pathways remain incompletely understood. Clinical diagnosis is challenging due to nonspecific symptoms that often resemble other respiratory conditions, leading to delays in recognition and treatment. Radiographic findings vary, with acute cases showing diffuse ground-glass opacities, while chronic cases may demonstrate reticular interstitial changes and fibrosis. The discontinuation of nitrofurantoin is the primary intervention, but corticosteroids may be beneficial, particularly in chronic cases with persistent inflammation or fibrosis, though their efficacy remains uncertain. Given the risk of long-term respiratory complications, heightened awareness among healthcare providers is essential for early diagnosis and intervention. Future research is needed to better define risk factors, improve diagnostic criteria, and explore alternative treatment strategies that mitigate the potential for pulmonary toxicity while maintaining effective antimicrobial therapy. This review explores the pathophysiology, clinical presentation, diagnostic challenges, and management strategies for nitrofurantoin-induced pulmonary toxicity.<\/jats:p>","DOI":"10.3390\/toxics13050382","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T04:13:44Z","timestamp":1746764024000},"page":"382","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Nitrofurantoin-Induced Pulmonary Toxicity: Mechanisms, Diagnosis, and Management"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2464-0187","authenticated-orcid":false,"given":"Alan D.","family":"Kaye","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7722-6716","authenticated-orcid":false,"given":"Shivam S.","family":"Shah","sequence":"additional","affiliation":[{"name":"School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"LaHaye","sequence":"additional","affiliation":[{"name":"School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Hennagin","sequence":"additional","affiliation":[{"name":"School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K.","family":"Ardoin","sequence":"additional","affiliation":[{"name":"School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Dubuisson","sequence":"additional","affiliation":[{"name":"School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahab","family":"Ahmadzadeh","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4545-4523","authenticated-orcid":false,"given":"Sahar","family":"Shekoohi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1093\/jac\/dkv147","article-title":"Nitrofurantoin revisited: A systematic review and meta-analysis of controlled trials","volume":"70","author":"Huttner","year":"2015","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1093\/jac\/33.suppl_A.23","article-title":"Nitrofurantoin: Mechanism of action and implications for resistance development in common uropathogens","volume":"33","author":"McOsker","year":"1994","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.urols.2016.07.004","article-title":"Risks of long-term use of nitrofurantoin for urinary tract prophylaxis in the older patient","volume":"27","author":"Rego","year":"2016","journal-title":"Urol. Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1378\/chest.96.3.512","article-title":"Hospitalizations for Pulmonary Reactions following Nitrofurantoin Use","volume":"96","author":"Jick","year":"1989","journal-title":"Chest"},{"key":"ref_5","first-page":"180","article-title":"Pulmonary reactions to nitrofurantoin. 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966\u20131976","volume":"62","author":"Holmberg","year":"1981","journal-title":"Eur. J. Respir. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.4065\/80.10.1298","article-title":"Chronic nitrofurantoin-induced lung disease","volume":"80","author":"Mendez","year":"2005","journal-title":"Mayo Clin. Proc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.4104\/pcrj.2012.00059","article-title":"Nitrofurantoin-induced lung disease and prophylaxis of urinary tract infections","volume":"21","author":"Madani","year":"2012","journal-title":"Prim. Care Respir. J. J. Gen. Pract. Airw. Group"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1465-9921-13-39","article-title":"Drug-induced interstitial lung disease: Mechanisms and best diagnostic approaches","volume":"13","author":"Matsuno","year":"2012","journal-title":"Respir. Res."},{"key":"ref_9","first-page":"e9807","article-title":"Nitrofurantoin-Induced Pulmonary Toxicity: Always Review the Medication List","volume":"12","author":"Batzlaff","year":"2020","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/0006-2952(86)90350-3","article-title":"Reductive metabolism of nitrofurantoin by rat lung and liver in vitro","volume":"35","author":"Minchin","year":"1986","journal-title":"Biochem. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jiph.2015.01.007","article-title":"Nitrofurantoin-induced pulmonary toxicity: A case report and review of the literature","volume":"8","author":"Kabbara","year":"2015","journal-title":"J. Infect. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/0006-2952(92)90621-O","article-title":"Nitrofurantoin-induced pulmonary toxicity. In vivo evidence for oxidative stress-mediated mechanisms","volume":"43","author":"Suntres","year":"1992","journal-title":"Biochem. Pharmacol."},{"key":"ref_13","first-page":"e34654","article-title":"A Possible Case of Nitrofurantoin-Associated Immune Thrombocytopenia in a Healthy 45-Year-Old Caucasian Female","volume":"15","author":"Ramey","year":"2023","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/1752-1947-2-169","article-title":"Nitrofurantoin-induced pulmonary fibrosis: A case report","volume":"2","author":"Goemaere","year":"2008","journal-title":"J. Med. Case Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100194","DOI":"10.1016\/j.medidd.2024.100194","article-title":"Repurposing nitrofurantoin as a stimulant of fibroblast extracellular matrix repair for the treatment of emphysema","volume":"23","author":"Leslie","year":"2024","journal-title":"Med. Drug Discov."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1378\/chest.89.1.150","article-title":"Chronic Nitrofurantoin Reaction Associated with T-Lymphocyte Alveolitis","volume":"89","author":"Brutinel","year":"1986","journal-title":"Chest"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e237571","DOI":"10.1136\/bcr-2020-237571","article-title":"Acute lung toxicity by nitrofurantoin","volume":"14","author":"Milazzo","year":"2021","journal-title":"BMJ Case Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"dlac045","DOI":"10.1093\/jacamr\/dlac045","article-title":"Nitrofurantoin and glucose-6-phosphate dehydrogenase deficiency: A safety review","volume":"4","author":"Recht","year":"2022","journal-title":"JAC-Antimicrob. Resist."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/0002-9343(80)90443-X","article-title":"Adverse reactions to nitrofurantoin. Analysis of 921 reports","volume":"69","author":"Holmberg","year":"1980","journal-title":"Am. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/jgs.14072","article-title":"Evaluation of the Risk of Nitrofurantoin Lung Injury and Its Efficacy in Diminished Kidney Function in Older Adults in a Large Integrated Healthcare System: A Matched Cohort Study","volume":"64","author":"Santos","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1007\/s00228-023-03507-2","article-title":"Nitrofurantoin for the treatment of uncomplicated urinary tract infection in female patients: The impact of dosing regimen, age, and renal function on drug exposure","volume":"79","author":"Muller","year":"2023","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1002\/ccr3.3314","article-title":"A rare case of nitrofurantoin-induced acute lung injury","volume":"8","author":"Karmali","year":"2020","journal-title":"Clin. Case Rep."},{"key":"ref_23","first-page":"e44730","article-title":"Nitrofurantoin-Induced Lung Injury: A Reminder of an Overlooked Threat","volume":"15","author":"Suliman","year":"2023","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Aronson, J.K. (2014). Meyler\u2019s Side Effects of Drugs 15E: The International Encyclopedia of Adverse Drug Reactions and Interactions, Newnes.","DOI":"10.1016\/B978-0-444-62635-6.09983-6"},{"key":"ref_25","first-page":"713","article-title":"Nitrofurantoin-Induced Alterations in Pulmonary Tissue","volume":"85","author":"Taskinen","year":"1977","journal-title":"Acta Pathol. Microbiol. Scand."},{"key":"ref_26","first-page":"41","article-title":"Nitrofurantoin-induced acute, subacute and chronic pulmonary reactions","volume":"58","author":"Lemola","year":"1977","journal-title":"Scand. J. Respir. Dis."},{"key":"ref_27","first-page":"001295","article-title":"Consider Nitrofurantoin as a Cause of Lung Injury","volume":"6","author":"Almeida","year":"2019","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/S0009-9260(05)80161-8","article-title":"High-resolution computed tomography of drug-induced lung disease","volume":"46","author":"Padley","year":"1992","journal-title":"Clin. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1056\/NEJM196812052792304","article-title":"Chronic Nitrofurantoin Pulmonary Reaction","volume":"279","author":"Rosenow","year":"1968","journal-title":"N. Engl. J. Med."},{"key":"ref_30","first-page":"817","article-title":"Nitrofurantoin pulmonary toxicity","volume":"13","author":"Hainer","year":"1981","journal-title":"J. Fam. Pract."},{"key":"ref_31","first-page":"e2023050","article-title":"Long term nitrofurantoin induced interstitial lung disease: A case series and literature review","volume":"40","author":"Naureen","year":"2023","journal-title":"Sarcoidosis Vasc. Diffus. Lung Dis. Off. J. WASOG"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/0736-4679(89)90403-4","article-title":"Acute pulmonary toxicity to nitrofurantoin","volume":"7","author":"Chudnofsky","year":"1989","journal-title":"J. Emerg. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4103\/0022-3859.32211","article-title":"Severe nitrofurantoin lung disease resolving without the use of steroids","volume":"53","author":"Bhullar","year":"2007","journal-title":"J. Postgrad. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.chest.2021.06.057","article-title":"Presenting Features and Clinical Course of Chronic Nitrofurantoin-Induced Lung Toxicity","volume":"161","author":"Tzilas","year":"2022","journal-title":"Chest"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"bcr2013009299","DOI":"10.1136\/bcr-2013-009299","article-title":"Nitrofurantoin related pulmonary disease: A clinical reminder","volume":"2013","author":"Reynolds","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e920386","DOI":"10.12659\/AJCR.920386","article-title":"Interstitial Lung Disease Secondary to Long-Term Nitrofurantoin Use","volume":"21","author":"Chin","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_37","first-page":"e56097","article-title":"History Is the Key to Diagnosis: A Case of Nitrofurantoin-Induced Interstitial Lung Disease","volume":"16","author":"Akopyan","year":"2024","journal-title":"Cureus"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1111\/all.15017","article-title":"Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment","volume":"77","author":"Barnes","year":"2022","journal-title":"Allergy"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1164\/rccm.201611-2201PP","article-title":"Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management","volume":"196","author":"Vasakova","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"17074","DOI":"10.1038\/nrdp.2017.74","article-title":"Idiopathic pulmonary fibrosis","volume":"3","author":"Martinez","year":"2017","journal-title":"Nat. Rev. Dis. Primer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.rx.2022.10.009","article-title":"Idiopathic pulmonary fibrosis","volume":"64","year":"2022","journal-title":"Radiologia"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"bcr2015213967","DOI":"10.1136\/bcr-2015-213967","article-title":"Nitrofurantoin-induced interstitial pneumonitis: Albeit rare, should not be missed","volume":"2016","author":"Syed","year":"2016","journal-title":"BMJ Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2324709620984610","DOI":"10.1177\/2324709620984610","article-title":"Systemic Inflammatory Response Syndrome Secondary to Nitrofurantoin","volume":"9","author":"McGarry","year":"2021","journal-title":"J. Investig. Med. High Impact Case Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.cmi.2016.08.003","article-title":"Nitrofurantoin\u2019s efficacy and safety as prophylaxis for urinary tract infections: A systematic review of the literature and meta-analysis of controlled trials","volume":"23","author":"Muller","year":"2017","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"333","DOI":"10.5603\/ARM.2017.0057","article-title":"Spontaneous Resolution of Nitrofurantoin-Induced Chronic Pulmonary Toxicity Presenting with Respiratory Failure","volume":"85","author":"Mir","year":"2017","journal-title":"Adv. Respir. Med."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Richeldi, L., Davies, H.R.H.R., Spagnolo, P., and Luppi, F. (2003). Corticosteroids for idiopathic pulmonary fibrosis. Cochrane Database Syst. Rev., CD002880.","DOI":"10.1002\/14651858.CD002880"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/rcr2.131","article-title":"Nitrofurantoin-induced acute pulmonary toxicity","volume":"4","author":"Livanios","year":"2016","journal-title":"Respirol. Case Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"491","DOI":"10.4103\/lungindia.lungindia_283_22","article-title":"Antifibrotic in interstitial lung diseases: When, where, and how long?","volume":"39","author":"Rai","year":"2022","journal-title":"Lung India Off. Organ Indian Chest Soc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"240059","DOI":"10.5888\/pcd21.240059","article-title":"Asthma Hot Spots in New York Before and During the COVID-19 Pandemic","volume":"21","author":"Skochko","year":"2024","journal-title":"Prev. Chronic. Dis."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.cmi.2020.05.011","article-title":"Nitrofurantoin, monoliths and taboos","volume":"26","author":"Huttner","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_51","unstructured":"The Cochrane Collaboration (2006). Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1186\/s13063-018-2998-4","article-title":"ALternatives To prophylactic Antibiotics for the treatment of Recurrent urinary tract infection in women (ALTAR): Study protocol for a multicentre, pragmatic, patient-randomised, non-inferiority trial","volume":"19","author":"Forbes","year":"2018","journal-title":"Trials"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/SMJ.0000000000000059","article-title":"Nitrofurantoin-Induced Hepatotoxicity: A Rare Yet Serious Complication","volume":"107","author":"Sakaan","year":"2014","journal-title":"South. Med. J."}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/5\/382\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:29:51Z","timestamp":1760030991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/13\/5\/382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,9]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["toxics13050382"],"URL":"https:\/\/doi.org\/10.3390\/toxics13050382","relation":{},"ISSN":["2305-6304"],"issn-type":[{"value":"2305-6304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,9]]}}}