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Archives of Industrial Hygiene and Toxicology

The Journal of Institute for Medical Research and Occupational Health

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Nitrofurantoin-Induced Acute Liver Damage in Pregnancy

Alenka Akšamija1 / Gordana Horvat1 / Dubravko Habek1 / Damir Žalac1 / Eva Jendriš1

Department of Obstetrics and Gynaecology, Sveti Duh General Hospital Zagreb, Zagreb, Croatia1

Department of Obstetrics and Gynaecology, Polyclinic Sunce, Zagreb, Croatia2

This content is open access.

Citation Information: Archives of Industrial Hygiene and Toxicology. Volume 60, Issue 3, Pages 357–361, ISSN (Print) 0004-1254, DOI: 10.2478/10004-1254-60-2009-1940, September 2009

Publication History

Published Online:
2009-09-29

Nitrofurantoin-Induced Acute Liver Damage in Pregnancy

This article presents a rare case of acute toxic hepatitis in thirty-one-year old primigravida. In the 36th week of gestation, the patient was introduced nitrofurantoin 100 mg a day due to symptoms of dysuria and enterococcus isolated from urine culture. After induced delivery at term because of hypertension, repeated laboratory findings showed increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and negative hepatitis C and B markers. The patient was subicteric at the time. Coagulation and complete blood count values were within the normal range. Nitrofurantoin therapy was discontinued. Abdominal ultrasound was normal with the exception of a slight hepatomegaly without any lesions, focal or diffuse. Given that discontinuation of nitrofurantoin and introduction of methylprednisolon therapy significantly lowered liver enzyme levels, restoring most of them to normal, we concluded that this was probably the case of toxic liver damage caused by nitrofurantoin.

Akutno oštećenje jetre uzrokovano primjenom nitrofurantoina u trudnoći

Autori prikazuju rijedak slučaj akutnog oštećenja jetre - akutni toksični hepatitis u 31-godišnje primigravide. U 36. tjednu trudnoće zbog dizuričnih smetnji i dokazanog enterokoka u urinokulturi ordiniran je nitrofurantoin 1×100 mg. Nakon terminski induciranoga poroda zbog hipertenzije, ponovljene laboratorijske pretrage upućuju na značajno povišenje vrijednosti jetrenih enzima uz negativne markere na C i B-hepatitis te subikterus. Koagulogram i crvena krvna slika bili su uredni. Nitrofurantoin se isključuje iz terapije. Abdominalni ultrazvuk upućuje na hepatomegaliju bez fokalnih ili difuznih oštećenja.

Nakon isključenja nitrofurantoina iz terapije uz metilprednizolon, vrijednosti jetrenih enzima se normaliziraju, što potvrđuje slučaj toksičnog oštećenja jetre uzrokovanog nitrofurantoinom.

Keywords: antibiotic; hepatotoxicity; pregnant woman; therapy

Keywords: antibiotik; gravidne žene; hepatotoksičnost; terapija

  • Guay DR. An update on the role of nitrofurans in the management of urinary tract infections. Drugs 2001;61:353-64.

  • Abboud G, Kaplowitz N. Drug-induced liver injury. Drug Saf 2007;30:277-94.

  • Boelsterli UA, Ho HK, Zhou S, Leow KJ. Bioactivation and hepatotoxicitiy of nitroaromatic drugs. Curr Drug Metab 2006;7:715-27.

  • Holmberg L, Boman G, Bottiger LE, Eriksson B, Spross R, Wessling A. Adverse reactions to nitrofurantoin. Analysis of 921 reports. Am J Med 1980;69:733-8.

  • Vrhovac B. Farmakoterapijski priručnik [Manual of Pharmacotherapy, in Croatian], 5th edition. Zagreb: Medicinska naklada; 2007.

  • Beigel R, Perets R, Mouallem M. Acute kidney injury, hepatitis, and CPK elevation associated with nitrofurantoin therapy. Am J Med Sci 2009;337:132-3.

  • Bruel H, Guillemant V, Saladin-Thiron C, Chabrolle JP, Lahary A, Poinsot J. Anéie héolytique chez un nouveauné aprè prise maternelle de nitrofurantoïne en fin de grossesse [Hemolytic anemia in a newborn after maternal treatment with nitrofurantoin at the end of pregnancy, in French]. Arch Pediatr 2000;7:745-7.

  • Heber MF, Roberts JP. Endstage liver disease associated with nitrofurantoin requiring liver transplantation. Ann Pharmacother 1993;27:1193-4.

  • Millson LC, Angus P, Richards M, Jones RM, Ireton J. Hepatitis due to nitrofurantoin. Med J Aust 1992;156:347-9.

  • Volbeda F, Jonker AM, Vecht J, Groeneveld PH. Levercirrose door chronisch gebruik van nitrofurantoïne [Liver cirrhosis due to chronic use of nitrofurantoin, in Dutch]. Ned Tijdschr Geneeskd 2004;148:235-8.

  • Dam-Larsen S, Kromann-Andersen H. Nitrofurantoin-levertoksicitet. Tilfaelde indberettet til Bivirkningsnaevnet 1968-1998. [Hepatic toxicity of nitrofurantoin. Cases reported to the Center for Monitoring Adverse Drug Reactions 1968-1998, in Danish]. Ugeskr Laeger 1999;161:6650-2.

  • Amit G, Cohen P, Ackerman Z. Nitrofurantoin-induced chronic active hepatitis. Isr Med Assoc J 2002;4:184-6.

  • Paterna JC, Boess F, Stäubli A, Boelsterli UA. Antioxidant and cytoprotective properties of D-tagatose in cultured murine hepatocytes. Toxicol Appl Pharmacol 1998;148:117-25.

  • Kelly BD, Heneghan MA, Bennani F, Connolly CE, O'Gorman TA. Nitrofurantoin-induced hepatotoxicity mediated by CD8+ T cells. Am J Gastroenterol 1998;93:819-21.

  • Paiva LA, Wright PJ, Koff RS. Long-term hepatic memory for hypersensitivity to nitrofurantoin. Am J Gastroenterol 1992;87:891-3.

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