S125 Establishing prescribing habits and complication awareness of nitrofurantoin, and the impact of adverse effects following prophylactic prescription

Introduction Nitrofurantoin (NF) is prescribed for urinary tract infections (UTIs). Associated adverse pulmonary and hepatic side-effects are known. Current monitoring guidelines1 2 lack specific recommendations for monitoring. This work formed part of a clinical effectiveness project to raise awareness of side effects of prophylactic NF and allow recommendations for monitoring. Methods We undertook 1) Audit (1st-31st July 2020) of GP surgeries in local clinical commissioning group (CCG) who prescribed prophylactic NF and assessed their monitoring habits. (2) Assessment of GPs’ and urologists’ prescribing habits and awareness of complications associated with prophylactic NF. (3) Audit of patients diagnosed with nitrofurantoin-induced interstitial lung disease (NFILD) by our ILD center (2014–2020). Results 503 patients in local CCG were prescribed prophylactic NF at time of audit. 265/503 were on prophylaxis for 0–2 years, 40% of these for >6 months to 2 years. Of those patients on NF >6 months to 2 years, 45% received no monitoring, 21% received both lung and liver monitoring, 20% received only liver monitoring and 14% received only lung. 238/503 patients were on prophylaxis for >2 years; in this cohort 20% received no monitoring, 44% received both lung and liver monitoring, 21% received only liver monitoring and 15% received only lung. Of 125 questionnaire respondents prescribing prophylactic NF, 82% were GPs and 12% urologists. 47% followed CCG guidelines whilst 38% followed national guidelines. 58% were aware of liver complications and 72% aware of respiratory. However, 41% and 53% were never monitored for liver and lung complications respectively. Our centre diagnosed 46 patients with NIILD. 80.4% were female, mean age 72 years. 70% were prescribed NF for recurrent UTIs and 58.7% were prescribed for >6 months. Of this cohort, 61% displayed resolution (complete/with minimal fibrosis) on HRCT following removal of NF, 16% developed fibrosis and 23% showed no interval change. There was no difference in subset analysis of those treated with steroids from those not. Conclusion NF complications can bear significant impact on patient’s health. Improving awareness and monitoring is crucial and must be addressed. Increased clarity of monitoring guidelines will circumvent side effects of NF. References https://bnf.nice.org.uk/drug/nitrofurantoin.html https://remedy.bnssgccg.nhs.uk/media/3207/recurrent-utis-in-women-may-17.pdf