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Sanyaolu L, Best V, Cannings-John R, Wood F, Edwards A, Akbari A, Hayward G, Ahmed H. Recurrent urinary tract infections and prophylactic antibiotic use in women: a cross-sectional study in primary care. Br J Gen Pract 2024; 74:e619-e627. [PMID: 38950943 PMCID: PMC11349348 DOI: 10.3399/bjgp.2024.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/13/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Despite the considerable morbidity caused by recurrent urinary tract infections (rUTIs), and the wider personal and public health implications from frequent antibiotic use, few studies adequately describe the prevalence and characteristics of women with rUTIs or those who use prophylactic antibiotics. AIM To describe the prevalence, characteristics, and urine profiles of women with rUTIs with and without prophylactic antibiotic use in Welsh primary care. DESIGN AND SETTING This was a retrospective cross-sectional study in Welsh general practice using the Secure Anonymised Information Linkage (SAIL) Databank. METHOD The characteristics of women aged ≥18 years with rUTIs or using prophylactic antibiotics from 2010 to 2020, and associated urine culture results from 2015 to 2020, are described. RESULTS In total, 6.0% (n = 92 213/N = 1 547 919) had rUTIs, and 1.7% (n = 26 862/N = 1 547 919) were prescribed prophylactic antibiotics with the rates increasing after 57 years of age. Only 49.0% (n =13 149/N = 26 862) of users of prophylactic antibiotics met the definition of rUTIs before initiation. The study found that 80.8% (n = 44 947/N = 55 652) of women with rUTIs had a urine culture result in the preceding 12 months with high rates of resistance to trimethoprim and amoxicillin. Of women taking prophylactic antibiotics, 64.2% (n = 9926/N = 15 455) had a urine culture result before initiation and 18.5% (n = 320/N = 1730) of women prescribed trimethoprim had resistance to it on the antecedent sample. CONCLUSION A substantial proportion of women had rUTIs or incident prophylactic antibiotic use. However, 64.2% (n = 9926/N = 15 455) of women had urine cultured before starting prophylaxis. There was a high proportion of cultured bacteria resistant to two antibiotics used for rUTI prevention and evidence of resistance to the prescribed antibiotic. More frequent urine cultures for rUTI diagnosis and before prophylactic antibiotic initiation could better inform antibiotic choices.
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Affiliation(s)
- Leigh Sanyaolu
- Division of Population Medicine and PRIME Centre Wales, Cardiff University, Cardiff
| | - Victoria Best
- Population Data Science, Swansea University, Swansea
| | | | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, Cardiff University, Cardiff
| | - Adrian Edwards
- Division of Population Medicine and PRIME Centre Wales, Cardiff University, Cardiff
| | - Ashley Akbari
- Population Data Science, Swansea University, Swansea
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Haroon Ahmed
- Division of Population Medicine and PRIME Centre Wales, Cardiff University, Cardiff
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Bessone F, Ferrari A, Hernandez N, Mendizabal M, Ridruejo E, Zerega A, Tanno F, Reggiardo MV, Vorobioff J, Tanno H, Arrese M, Nunes V, Tagle M, Medina-Caliz I, Robles-Diaz M, Niu H, Alvarez-Alvarez I, Stephens C, Lucena MI, Andrade RJ. Nitrofurantoin-induced liver injury: long-term follow-up in two prospective DILI registries. Arch Toxicol 2023; 97:593-602. [PMID: 36416910 PMCID: PMC9859893 DOI: 10.1007/s00204-022-03419-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
Nitrofurantoin is a synthetic antibiotic that is recommended as first-choice treatment for uncomplicated urinary tract infections. The prescription of this drug has increased dramatically, especially in Latin American countries. We described the demographics, clinical characteristics, biochemical features, and outcome of nitrofurantoin-induced liver injury. We analyzed 23 cases from the Latin American DILI Network (LATINDILI) and the Spanish DILI Registry. Causality was assessed with the RUCAM and RECAM scale. Of the 23 DILI cases included in our series, 96% patients were women, and the mean age of the whole cohort was 61 years. The median time of drug exposure was 175 days (interquartile range [IQR] 96-760), with 11 patients who were prescribed nitrofurantoin for more than six months. Hepatocellular damage was the most frequent pattern of liver injury (83%), and nearly half of the patients had an asymptomatic presentation (52%). Neither death nor liver transplantation was documented in this series. Overall, 65% of the patients (n = 15) presented with positive autoantibody titres. The median time to resolution was 81 days (IQR 57-141), and 15 patients (83%) recovered within six months. Five patients (22%) developed nitrofurantoin-induced autoimmune-like hepatitis (NI-AILH), of whom two were characterized by a persistent increase in transaminases that required immunosuppressive treatment to achieve normalization of liver enzymes. Clinicians who prescribe nitrofurantoin should be aware that patients who had taken nitrofurantoin for a long term may be at risk of developing nitrofurantoin-induced autoimmune-like hepatitis.
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Affiliation(s)
| | | | | | | | - Ezequiel Ridruejo
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | | | | | | | | | - Hugo Tanno
- Hospital Provincial del Centenario, Rosario, Argentina
| | - Marco Arrese
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vinicius Nunes
- Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil
| | | | - Inmaculada Medina-Caliz
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
| | - Mercedes Robles-Diaz
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Hao Niu
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ismael Alvarez-Alvarez
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Camilla Stephens
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - M. Isabel Lucena
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Raul J. Andrade
- Servicios de Aparato Digestivo y Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Universidad de Málaga, Málaga, Spain ,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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[On the trail of dyspnea. An exclusion diagnosis]. Rev Esp Geriatr Gerontol 2023; 58:49-50. [PMID: 36473765 DOI: 10.1016/j.regg.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/29/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
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Vickery SB, Burch AD, Vickery PB. Differentiating probable nitrofurantoin-induced drug fever from antipsychotic-induced hyperthermia in a patient receiving clozapine. Ment Health Clin 2022; 12:205-209. [PMID: 35801160 PMCID: PMC9190270 DOI: 10.9740/mhc.2022.06.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Nitrofurantoin (NIT) is a commonly utilized antibiotic for the treatment of UTIs. Although well tolerated, NIT is not without potential adverse reactions. This case report details the observation of probable NIT-induced drug fever in a patient receiving clozapine. A 61-year-old female with treatment-refractory schizoaffective disorder was admitted to a psychiatric unit with paranoia and auditory hallucinations, prompting clozapine initiation during day 1 of hospitalization. Due to worsening hallucinations and anxiety, antibiotic therapy with NIT for a presumed UTI was initiated 8 days after admission. Febrile episodes were observed beginning on hospital day (HD) 9, leading to concern for possible neuroleptic malignant syndrome (NMS), which led to clozapine discontinuation. The patient received a total of 3 doses of NIT with continued fever until discontinuation on HD 10. No further complications were encountered, and clozapine was safely resumed on HD 13. Although sparsely described in the medical literature, occurrences of drug fever attributable to NIT are previously reported. A review of the medical literature identified only 5 previously published articles specific to NIT-induced drug fever, none of which specified interruptions of psychotropic therapy for a patient with acute psychiatric decompensation. This case highlights the differential diagnosis of fever related to NIT in a patient receiving clozapine when NMS was initially suspected.
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Affiliation(s)
| | - Andrew D. Burch
- 2 PharmD Student, Wingate University School of Pharmacy, Hendersonville, North Carolina
| | - P. Brittany Vickery
- 3 Associate Professor, Wingate University School of Pharmacy, Hendersonville, North Carolina
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Evaluation of the Anti-Histoplasma capsulatum Activity of Indole and Nitrofuran Derivatives and Their Pharmacological Safety in Three-Dimensional Cell Cultures. Pharmaceutics 2022; 14:pharmaceutics14051043. [PMID: 35631629 PMCID: PMC9147190 DOI: 10.3390/pharmaceutics14051043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Histoplasma capsulatum is a fungus that causes histoplasmosis. The increased evolution of microbial resistance and the adverse effects of current antifungals help new drugs to emerge. In this work, fifty-four nitrofurans and indoles were tested against the H. capsulatum EH-315 strain. Compounds with a minimum inhibitory concentration (MIC90) equal to or lower than 7.81 µg/mL were selected to evaluate their MIC90 on ATCC G217-B strain and their minimum fungicide concentration (MFC) on both strains. The quantification of membrane ergosterol, cell wall integrity, the production of reactive oxygen species, and the induction of death by necrosis–apoptosis was performed to investigate the mechanism of action of compounds 7, 11, and 32. These compounds could reduce the extracted sterol and induce necrotic cell death, similarly to itraconazole. Moreover, 7 and 11 damaged the cell wall, causing flaws in the contour (11), or changing the size and shape of the fungal cell wall (7). Furthermore, 7 and 32 induced reactive oxygen species (ROS) formation higher than 11 and control. Finally, the cytotoxicity was measured in two models of cell culture, i.e., monolayers (cells are flat) and a three-dimensional (3D) model, where they present a spheroidal conformation. Cytotoxicity assays in the 3D model showed a lower toxicity in the compounds than those performed on cell monolayers. Overall, these results suggest that derivatives of nitrofurans and indoles are promising compounds for the treatment of histoplasmosis.
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Synthesis and Evaluation of the Antifungal and Toxicological Activity of Nitrofuran Derivatives. Pharmaceutics 2022; 14:pharmaceutics14030593. [PMID: 35335969 PMCID: PMC8950151 DOI: 10.3390/pharmaceutics14030593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
Fungal diseases affect more than 1 billion people worldwide. The constant global changes, the advent of new pandemics, and chronic diseases favor the diffusion of fungal pathogens such as Candida, Cryptococcus, Aspergillus, Trichophyton, Histoplasma capsulatum, and Paracoccidioides brasiliensis. In this work, a series of nitrofuran derivatives were synthesized and tested against different fungal species; most of them showed inhibitory activity, fungicide, and fungistatic profile. The minimal inhibitory concentration (MIC90) values for the most potent compounds range from 0.48 µg/mL against H. capsulatum (compound 11) and P. brasiliensis (compounds 3 and 9) to 0.98 µg/mL against Trichophyton rubrum and T. mentagrophytes (compounds 8, 9, 12, 13 and 8, 12, 13, respectively), and 3.9 µg/mL against Candida and Cryptococcus neoformans strains (compounds 1 and 5, respectively). In addition, all compounds showed low toxicity when tested in vitro on lung cell lines (A549 and MRC-5) and in vivo in Caenorhabditis elegans larvae. Many of them showed high selectivity index values. Thus, these studied nitrofuran derivatives proved to be potent against different fungal species, characterized by low toxicity and high selectivity; for these reasons, they may become promising compounds for the treatment of mycoses.
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Langford BJ, Brown KA, Diong C, Marchand-Austin A, Adomako K, Saedi A, Schwartz KL, Johnstone J, MacFadden DR, Matukas LM, Patel SN, Garber G, Daneman N. The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults. Clin Infect Dis 2021; 73:e782-e791. [PMID: 33595621 DOI: 10.1093/cid/ciab116] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. METHODS We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. RESULTS Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12-1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18-1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80-2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI, .94-1.22), the risk of Clostridioidesdifficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05-2.23] and 1.62 [1.11-2.29], respectively). CONCLUSIONS Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.
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Affiliation(s)
- Bradley J Langford
- Public Health Ontario, Toronto, Ontario, Canada.,Hotel Dieu Shaver Health and Rehabilitation Centre, St Catharines, Ontario, Canada
| | - Kevin A Brown
- Public Health Ontario, ICES, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | | | | | | | - Kevin L Schwartz
- Public Health Ontario, ICES, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Public Health Ontario, Sinai Health, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Larissa M Matukas
- Unity Health Toronto, University of Toronto Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| | - Samir N Patel
- Public Health Ontario, University of Toronto Department of Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| | - Gary Garber
- Public Health Ontario, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Sunnybrook Health Sciences Center, ICES, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Ten Doesschate T, Hendriks K, van Werkhoven CH, van der Hout EC, Platteel TN, Groenewegen IAM, Muller AE, Hoepelman AIM, Bonten MJM, Geerlings SE. Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study. Clin Microbiol Infect 2021; 28:248-254. [PMID: 34111584 DOI: 10.1016/j.cmi.2021.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Guidelines do not distinguish between 50 mg or 100 mg nitrofurantoin as daily prophylaxis for recurrent urinary tract infection (UTI), although 50 mg might have a better safety profile. Our objective was to compare the effectiveness and safety of both regimens. METHODS Data were retrospectively collected from 84 Dutch GP practices between 2013 and 2020. Nitrofurantoin prescriptions of 100 mg and 50 mg every 24 hours in women were included. Cox proportional hazard regression analysis was used to calculate hazard ratios on first episode of UTI, pyelonephritis and (adverse) events. Patients were followed for the duration of consecutive repeated prescriptions, assuming non-informative right censoring, up to 1 year. RESULTS Nitrofurantoin prophylaxis was prescribed in 1893 patients. Median lengths of follow up were 90 days (interquartile range (IQR) 37-179 days) for 100 mg (n = 551) and 90 days (IQR 30-146 days) for 50 mg (n = 1342) with few differences in baseline characteristics between populations. Under 100 mg and 50 mg, 82/551 (14.9%) and 199/1342 (14.8%) developed UTI and 46/551 (8.3%) and 81/1342 (6.0%) developed pyelonephritis, respectively. Adjusted HRs of 100 mg versus 50 mg were 1.01 (95% CI 0.78-1.30) on first UTI, 1.37 (95% CI 0.95-1.98) on first pyelonephritis episode, 1.82 (95% CI 1.20-2.74) on first consultation for cough, 2.68 for dyspnoea (95% CI 1.11-6.45) and 2.43 for nausea (95% CI 1.03-5.74). CONCLUSION Daily prophylaxis for recurrent UTI with 100 mg instead of 50 mg nitrofurantoin was associated with an equivalent hazard on UTI or pyelonephritis, and a higher hazard on cough, dyspnoea and nausea. We recommend 50 mg nitrofurantoin as daily prophylaxis.
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Affiliation(s)
- Thijs Ten Doesschate
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands.
| | - Kelly Hendriks
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, Tergooi Hospital, Hilversum, the Netherlands
| | - Cornelis Henri van Werkhoven
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Evelien C van der Hout
- Department of Pulmonology, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Tamara N Platteel
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands; van Dijken (GP-practice), NG Veenendaal, the Netherlands
| | | | - Anouk E Muller
- Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, the Netherlands; Department of Medical Microbiology & Infectious Diseases, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Amsterdam University Medical Centre, Amsterdam-Zuidoost, the Netherlands
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Mariyappan V, Keerthi M, Chen SM, Jeyapragasam T. Nanostructured perovskite type gadolinium orthoferrite decorated RGO nanocomposite for the detection of nitrofurantoin in human urine and river water samples. J Colloid Interface Sci 2021; 600:537-549. [PMID: 34030010 DOI: 10.1016/j.jcis.2021.05.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022]
Abstract
Nitrofurantoin (NFT) is mainly used in humans for the treatment of urinary tract infections. NFT is used as feed additives in animals, due to its broad antimicrobial activity. However, it shows more side effects on human health and the environment. Therefore low-cost, portable, and rapid sensors are necessary for the detection of NFT in real samples. Herein, we successfully developed an electrochemical sensor using a glassy carbon electrode (GCE) modified with gadolinium orthoferrite (GdFeO3) decorated on reduced graphene oxide (RGO) nanocomposite for the detection of NFT. The facile hydrothermal method was used to synthesis a novel GdFeO3/RGO nanocomposite, the morphological and structural characterization was confirmed by the FESEM, HRTEM, EDX, XRD, Raman, and XPS techniques. The formation mechanism of GdFeO3/RGO nanocomposite had been discussed. The effective intercalation of the nanostructured GdFeO3 to the RGO sheets leads to the significant enhancement in physicochemical properties such as electrical conductivity, electro-active surface area, structural stability, and electrochemical activity, which was observed from the EIS and CV experimental results. The electrochemical studies established that the developed GdFeO3/RGO sensor was highly sensitive and selective to NFT. Moreover, the GdFeO3/RGO sensor exhibits good sensitivity of 4.1985 μA μM-1 cm-2, a low detection limit (LOD) of 0.0153 µM and a linear range from 0.001 to 249 µM for NFT detection under optimized experimental conditions. In addition, the investigation of storage time on the CV response of the GdFeO3/RGO sensor indicates superior stability. Owing to these extraordinary analytical advantages, the as-fabricated sensor was applied to detect the NFT levels in human urine and river water samples with satisfactory results.
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Affiliation(s)
- Vinitha Mariyappan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No.1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Murugan Keerthi
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No.1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan
| | - Shen-Ming Chen
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, No.1, Section 3, Chung-Hsiao East Road, Taipei 106, Taiwan.
| | - Tharini Jeyapragasam
- Department of Chemistry, V.P.M.M College of Arts and Science for Women, V.P.M. Nagar, Krishnankovil, Srivilliputur (T.K), Virudhunagar 626190, India
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10
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Speirs TP, Tuffin N, Mundy-Baird F, Sakota H, Mulholland S, Westlake M, Lyon M, Medford AR, Sharp C, Darby M, Albur M, Keeley F, Burden H, Kenward C, Jonas E, Barratt S, Adamali HI. Long-term nitrofurantoin: an analysis of complication awareness, monitoring, and pulmonary injury cases. BJGP Open 2021; 5:BJGPO.2021.0083. [PMID: 34407964 PMCID: PMC9447296 DOI: 10.3399/bjgpo.2021.0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Long-term nitrofurantoin (NF) treatment can result in pulmonary and hepatic injury. Current guidelines do not outline the type or frequency of monitoring required for detection of these injuries. AIM To assess 1) awareness of NF complications among prescribers; 2) monitoring practice; and 3) to describe the pulmonary sequelae of NF-related complications. DESIGN & SETTING Evaluation of prescribing habits by questionnaires and review of GP databases, and case-note review in secondary care. METHOD The following study procedures were undertaken: 1) an electronic questionnaire was distributed to prescribers, interrogating prescribing and monitoring practices, and awareness of complications; 2) an analysis was undertaken (June-July 2020) of NF monitoring among GPs in the local clinical commissioning group (CCG); and 3) a case review was carried out of patients diagnosed with NF-induced interstitial lung disease (NFILD) at the interstitial lung disease (ILD) centre (2014-2020). RESULTS A total of 125 prescribers of long-term NF responded to the questionnaire (82.4% GPs; 12.0% urologists). Many were unaware of the potential for liver (42.4%) and lung (28.0%) complications; 40.8% and 52.8% never monitored for these, respectively. Only 53.3% of urologists believed themselves responsible for arranging monitoring, while nearly all GPs believed this to be the prescriber's responsibility (94.2%). One-third of all responders considered current British National Formulary (BNF) guidelines 'not at all sufficient/clear', with mean clarity scoring of 2.2/5. Among patients with NFILD (n = 46), NF had been prescribed most often (69.6%) for treatment of recurrent UTI and 58.6% (n = 27) were prescribed for >6 months. On withdrawal of the medication 61.4% displayed resolution (completely or minimal fibrosis), while 15.9% of patients had progressive lung fibrosis. CONCLUSION NF can cause marked or irreversible lung complications and there is currently a shortfall in awareness and monitoring. Existing monitoring guidelines should be augmented.
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Affiliation(s)
- Toby Peter Speirs
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nicole Tuffin
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Finlay Mundy-Baird
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Helena Sakota
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Sarah Mulholland
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Michelle Westlake
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Max Lyon
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Andrew R Medford
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Charles Sharp
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Michael Darby
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - Mahableshwar Albur
- Department of Microbiology and Infectious Disease, North Bristol NHS Trust, Bristol, UK
| | - Francis Keeley
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Helena Burden
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Charlie Kenward
- NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, United Kingdom
| | - Elizabeth Jonas
- NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, Bristol, United Kingdom
| | - Shaney Barratt
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Huzaifa I Adamali
- Bristol Interstitial Lung Disease Service, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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11
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Leuin AS, Hartmann F, Viviano K. Administration of nitrofurantoin in dogs with lower urinary tract infections: 14 cases (2013-2019). J Small Anim Pract 2020; 62:42-48. [PMID: 33107048 DOI: 10.1111/jsap.13252] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the clinical use of nitrofurantoin in client-owned dogs with lower urinary tract infections. The primary aim was to describe the patient population, dosage, treatment duration, outcome and side effects. MATERIALS AND METHODS Medical records in an institution were retrospectively reviewed from July 2013 to January 2019. RESULTS Nitrofurantoin was prescribed in this clinical population of 14 client-owned dogs for lower urinary tract infections. Recurrent urinary tract infection was the clinical diagnosis in all dogs. Each dog's urinary tract infection was associated with a nitrofurantoin-susceptible, multidrug-resistant uropathogen. The median dosage and duration of nitrofurantoin treatment was 4.3 mg/kg by mouth every 8 hours for 14 days. Twelve of the 14 dogs had successful outcomes including bacteriologic cure (n = 9), clinical cure (2) and resolution of target bacteria (1). Treatment failures (n = 2) were associated with uropathogens developing progressive nitrofurantoin resistance. CLINICAL SIGNIFICANCE In some dogs with recurrent lower urinary tract infections, nitrofurantoin may be an effective antibiotic for treatment of nitrofurantoin-susceptible uropathogens. Treatment failures were associated with progressive uropathogen resistance. Urine bacterial culture and quantitative susceptibility testing are essential to initiating and monitoring treatment due to the multidrug-resistant isolates and, in some cases, persistent bacteriuria in the face of treatment.
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Affiliation(s)
- A S Leuin
- Veterinary Specialty Hospital - North County, 2055 Montiel Road, Unit 104, San Marcos, California, 92069, USA
| | - F Hartmann
- University Wisconsin Veterinary Care, University of Wisconsin-Madison, 2015 Linen Drive, Madison, Wisconsin, 53706, USA
| | - K Viviano
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Drive, Madison, Wisconsin, 53706, USA
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13
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Batzlaff C, Koroscil M. Nitrofurantoin-Induced Pulmonary Toxicity: Always Review the Medication List. Cureus 2020; 12:e9807. [PMID: 32953319 PMCID: PMC7494418 DOI: 10.7759/cureus.9807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Use of nitrofurantoin for uncomplicated cystitis and recurrent urinary tract infections is common practice. While the majority of patients tolerate this medication without issue, it is important to be cognizant of adverse reactions, as these can impact patient’s quality of life. Nitrofurantoin-induced pulmonary toxicity is a rare side effect that can present with various clinical manifestations, imaging abnormalities, and pathologic findings. We describe a case of chronic pneumonitis in a patient on suppressive nitrofurantoin therapy presenting with dyspnea and hypoxemia.
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Affiliation(s)
- Caitlin Batzlaff
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Matt Koroscil
- Department of Pulmonary and Critical Care Medicine, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, USA
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Khan TMA, Ansari Y, Siddiqui AH, Matthew H, Siddiqui F. Nitrofurantoin-associated Acute Pulmonary Toxicity Mimicking Severe Sepsis with Significantly Elevated Procalcitonin. Cureus 2019; 11:e5516. [PMID: 31687292 PMCID: PMC6819057 DOI: 10.7759/cureus.5516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nitrofurantoin is a commonly used treatment for urinary tract infections with a risk for pulmonary toxicity. We report a case of a 48-year-old woman on a prophylactic regimen of nitrofurantoin who exhibited classic signs of bacterial sepsis including elevated procalcitonin (PCL) and C-reactive protein (CRP) levels two days post-nephrolithotripsy. The microbial analysis did not reveal an infectious cause for the initial symptoms and, subsequently, the patient developed a dry cough, fever, chills, and transient hypoxemia requiring supplemental oxygen. Pulmonary imaging revealed significant abnormal features inconsistent with the patient's symptoms which indicated an inflammatory/immune reaction to nitrofurantoin. Treatment discontinuation improved the patient's symptoms and reduced PCL and CRP levels to within normal limits. A high index of suspicion for nitrofurantoin-associated pulmonary toxicity is warranted for patients on a regimen of nitrofurantoin who exhibit severe pulmonary symptoms and elevated PCL and CRP levels with no corresponding infection.
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Affiliation(s)
| | - Yusra Ansari
- Internal Medicine, Rawalpindi Medical College, Rawalpindi, PAK
| | - Abdul Hasan Siddiqui
- Pulmonary and Critical Care Medicine, Staten Island University Hospital / Northwell Health, Staten Island, USA
| | - Hall Matthew
- Infectious Disease, Marshfield Medical Center, Marshfield, USA
| | - Faraz Siddiqui
- Pulmonary and Critical Care Medicine, Robert Packer Hospital, Sayre, USA
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15
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Severe nitrofurantoin-induced adverse drug reactions: Is there a benefit of sequential therapy? Therapie 2019; 74:553-556. [PMID: 31027709 DOI: 10.1016/j.therap.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 03/26/2019] [Indexed: 11/24/2022]
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16
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Hanlon JT, Perera S, Drinka PJ, Crnich CJ, Schweon SJ, Klein-Fedyshin M, Wessel CB, Saracco S, Anderson G, Mulligan M, Nace DA. The IOU Consensus Recommendations for Empirical Therapy of Cystitis in Nursing Home Residents. J Am Geriatr Soc 2019; 67:539-545. [PMID: 30584657 PMCID: PMC7980083 DOI: 10.1111/jgs.15726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To establish consensus recommendations for empirical treatment of uncomplicated cystitis with anti-infectives in noncatheterized older nursing home residents to be implemented in the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. DESIGN Two-round modified Delphi survey. PARTICIPANTS Expert panel of 19 clinical pharmacists. MEASUREMENTS Comprehensive literature search and development/review/edit of draft survey by the investigative group (one geriatric clinical pharmacist, two geriatric medicine physicians, and one infectious disease physician). The expert panel members rated their agreement with each of 31 recommendations for drugs of choice, dosing medications at various levels of renal function, drug-drug interactions to avoid, and duration of therapy by sex on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Consensus agreement was defined as a lower 95% confidence limit of 4.0 or higher for the recommendation-specific mean score. RESULTS The response rate was 95% for the first round, and three recommendations achieved consensus (dosing for nitrofurantoin and trimethoprim/sulfamethoxazole in those without chronic kidney disease, and drug-drug interaction between trimethoprim/sulfamethoxazole and warfarin). In the second round, 90% responded and reached consensus on an additional eight recommendations (two for nitrofurantoin or trimethoprim/sulfamethoxazole as initial drugs of choice, three for dosing ciprofloxacin, nitrofurantoin, and trimethoprim/sulfamethoxazole at various levels of chronic kidney disease, and three drug-drug interactions to avoid: trimethoprim/sulfamethoxazole with phenytoin and ciprofloxacin with theophylline or with tizanidine). CONCLUSION An expert panel of clinical pharmacists was able to reach consensus on a set of recommendations for the empirical treatment of cystitis with oral anti-infective medications in older nursing home residents. The recommendations were incorporated into a treatment algorithm for uncomplicated cystitis in noncatheterized nursing home residents and used in educational materials for health professionals in an ongoing controlled intervention study. J Am Geriatr Soc 67:539-545, 2019.
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Affiliation(s)
- Joseph T Hanlon
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
- Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion (CHERP), VAPHS, Pittsburgh, Pennsylvania
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Paul J Drinka
- Divisions of Internal Medicine and Geriatric Medicine, University of Wisconsin, Madison, Wisconsin
| | - Christopher J Crnich
- Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- William S. Middleton Veterans Administration Medical Center, Madison, Wisconsin
| | | | | | - Charles B Wessel
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stacey Saracco
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gulsum Anderson
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Mulligan
- AMDA, The Society of Post-Acute and Long-Term Care Medicine, Columbia, Maryland
| | - David A Nace
- Division of Geriatric Medicine, Department of Medicine (Geriatrics), University of Pittsburgh, Pittsburgh, Pennsylvania
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Wong A, Seger DL, Lai KH, Goss FR, Blumenthal KG, Zhou L. Drug Hypersensitivity Reactions Documented in Electronic Health Records within a Large Health System. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1253-1260.e3. [PMID: 30513361 DOI: 10.1016/j.jaip.2018.11.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hypersensitivity reactions (HSRs) are immunologic responses to drugs. Identification of HSRs documented in the electronic health record (EHR) is important for patient safety. OBJECTIVE To examine HSR epidemiology using longitudinal EHR data from a large United States health care system. METHODS Patient demographic information and drug allergy data were obtained from the Partners Enterprise-wide Allergy Repository for 2 large tertiary care hospitals from 2000 to 2013. Drug-induced HSRs were categorized into immediate and delayed HSRs based on typical phenotypes. Causative drugs and drug groups were assessed. The prevalence of HSRs was determined, and sex and racial differences were analyzed. RESULTS Among 2.7 million patients, 377,474 (13.8%) reported drug-induced HSRs, of whom 70.3% were female and 77.5% were white. A total of 580,456 HSRs were reported, of which 53.1% were immediate reaction phenotypes. Common immediate HSRs included hives (48.8%), itching (15.0%), and angioedema (14.1%). Delayed HSR phenotypes (46.9%) were largely rash (99.0%). Penicillins were associated with the most immediate (33.0%) and delayed (39.0%) HSRs. Although most HSRs were more prevalent in females and white patients, notable differences were identified for certain rare HSRs including acute interstitial nephritis, which appeared more commonly in males (0.02% vs 0.01%, P < .001). Asian patients had more fixed drug eruptions (0.007% vs 0.002%, P = .021) and severe cutaneous adverse reactions (0.05% vs 0.04%, P < .001). CONCLUSIONS Drug HSRs were reported in 13.8% of patients. Almost one-half of reported immediate HSR phenotypes were hives, and almost all reported delayed HSR phenotypes were rash. HSRs largely affected female and white patients, but differences were identified for specific rare HSRs.
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Affiliation(s)
- Adrian Wong
- Department of Pharmacy Practice, MCPHS University, Boston, Mass; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass
| | - Diane L Seger
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Clinical and Quality Analysis, Partners HealthCare, Somerville, Mass
| | - Kenneth H Lai
- Clinical and Quality Analysis, Partners HealthCare, Somerville, Mass; Department of Computer Science, Brandeis University, Waltham, Mass
| | - Foster R Goss
- Department of Emergency Medicine, University of Colorado, Aurora, Colo
| | - Kimberly G Blumenthal
- Department of Medicine, Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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Martínez-Macías O, Pérez-Doñate V, Murcia-Soler M. Restricciones de la nitrofurantoína: luces y sombras. Med Clin (Barc) 2018; 151:422-423. [DOI: 10.1016/j.medcli.2018.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/01/2018] [Accepted: 02/15/2018] [Indexed: 10/17/2022]
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