Sakaan Sami A, Twilla Jennifer D, Usery Justin B, Winton John C, Self Timothy H
From the Methodist University Hospital and University of Tennessee Health Science Center Memphis.
South Med J. 2014 Feb;107(2):107-13. doi: 10.1097/SMJ.0000000000000059.
Nitrofurantoin is a commonly prescribed antibiotic for the treatment of recurrent uncomplicated urinary tract infections. Its importance has been emphasized by the current international clinical practice guidelines for the management of uncomplicated cystitis. Since its introduction into clinical practice, nitrofurantoin has been associated with various adverse effects, including hepatotoxicity. We searched the English-language literature using PubMed and SCOPUS for the period 1961 through the end of February 2013. Key search terms included "nitrofurantoin AND hepatotoxicity" as well as "nitrofurantoin AND hepatitis." When studies or case reports were found, we assessed articles cited in those publications. A broad spectrum of liver toxicity associated with nitrofurantoin use has been reported, ranging from acute hepatitis, granulomatous reaction, cholestasis, or autoimmune-mediated hepatitis to chronic active hepatitis that could lead to cirrhosis or death. The mechanism of hepatotoxicity is poorly understood, but it is believed to be the result of an immunologic process or a direct cytotoxic reaction. It has been postulated that prolonged exposure to nitrofurantoin, female sex, advanced age, and reduced renal function increase the risk of developing hepatotoxicity. For the management of severe cases, corticosteroids have been used along with nitrofurantoin discontinuation. Because of mixed results, the utility of corticosteroids has not been proven and should be used judiciously. Given the severity and seriousness of the adverse effect of hepatotoxicity, clinicians should weigh the risks and benefits of nitrofurantoin before initiating therapy, especially in long-term prophylaxis in high-risk patients. Clinicians also should be well versed in recognizing and managing liver injury associated with nitrofurantoin.
呋喃妥因是一种常用于治疗复发性单纯性尿路感染的抗生素。当前国际上关于单纯性膀胱炎管理的临床实践指南已强调了其重要性。自引入临床实践以来，呋喃妥因已与包括肝毒性在内的各种不良反应相关联。我们使用PubMed和SCOPUS检索了1961年至2013年2月底的英文文献。关键检索词包括“呋喃妥因与肝毒性”以及“呋喃妥因与肝炎”。当找到研究或病例报告时，我们评估了这些出版物中引用的文章。已报道了与使用呋喃妥因相关的广泛肝毒性，范围从急性肝炎、肉芽肿反应、胆汁淤积或自身免疫介导的肝炎到可能导致肝硬化或死亡的慢性活动性肝炎。肝毒性的机制尚不清楚，但据信是免疫过程或直接细胞毒性反应的结果。据推测，长期接触呋喃妥因、女性、高龄和肾功能减退会增加发生肝毒性的风险。对于严重病例的管理，已使用皮质类固醇并停用呋喃妥因。由于结果不一，皮质类固醇的效用尚未得到证实，应谨慎使用。鉴于肝毒性不良反应的严重性，临床医生在开始治疗前，尤其是在高危患者的长期预防中，应权衡呋喃妥因的风险和益处。临床医生还应精通识别和管理与呋喃妥因相关的肝损伤。
