Abstract
After treatment with nitrofurantoin for urinary tract infections, five patients developed peripheral polyneuropathies. Four of them had histories of chronic renal impairment. The first symptom was paresthesia, followed by muscle weakness and sensory impairment, all confined to the extremities. The symptoms appeared first in the fingers and toes and, if the drug was continued, progressed rapidly centripetally. Nitrofurantoin dosage ranged from 300 to 600 mg per day over periods of ten days to several years. Recovery was complete only when the drug was discontinued before marked muscle weakness had occurred. These cases are similar to 22 previously reported. Equal dosages of nitrofurantoin result in higher serum levels in patients with renal impairment than in those with normal renal function. In the presence of renal impairment this agent should be used with caution and discontinued at the first signs of neurotoxicity.
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