Nitrofurantoin-induced liver failure: A fatal yet forgotten complication

Nitrofurantoin is recommended as first-line therapy for uncomplicated cystitis owing to its comparable efficacy to cotrimoxazole, minimal resistance, and reduced risk of inducing resistance. It has also been recommended as prophylaxis for recurrent cystitis. Most clinicians are familiar with the risk of peripheral neuropathy and pulmonary toxicity as adverse effects of nitrofurantoin; however, hepatotoxicity, which might present after acute or chronic use and which can be fatal, might be overlooked. Here, Luk et al describe the fatal course of a patient with a drug-induced liver injury secondary to chronic nitrofurantoin use. They highlight the potential manifestations of nitrofurantoin-induced liver injury and offer suggestions for monitoring should chronic use be initiated.