A man died after medical professionals failed to ensure he understood the serious risks of taking antibiotics for more than six months.
A paraplegic man used intermittent self-catheterization to control his loss of bladder control.
As a result, he suffered from chronic urinary tract infections and in 2017 was prescribed the antibiotic nitrofurantoin by a specialist in the spine unit at the District Health Board (now Health NZ Te Whatu Ora).
The man’s treatment was the subject of a complaint to the Health and Disability Commissioner (HDC), which found that healthcare professionals had failed to adequately inform him about the risks of taking nitrofurantoin long-term.
According to MedsafeTaking nitrofurantoin for more than 6 months can cause pulmonary toxicity (lung damage).
Because the medication effectively cured the man’s symptoms, the man’s GP and a urologist at another public hospital continued to prescribe the drugs without making him understand the risks of using them for more than six months, HDC found.
The pharmacy that dispensed the drugs also did not advise him of the risks.
He ended up taking nitrofurantoin for 28 months over a three-year period without being warned about the risks of lung disease.
“According to [the man’s wife]”Her husband was completely unaware of the risk of lung disease associated with use of nitrofurantoin for more than six months,” the report states.
“[His wife] She told HDC that after taking nitrofurantoin for approximately six to eight months, her husband initially developed a mild dry cough but did not raise any concerns about this at the time as she did not know this was related to nitrofurantoin.”
He died in 2019 from complications of nitrofurantoin-related pulmonary toxicity.
“As a result, he did not have the opportunity to make an informed decision about whether the potential benefits of continuing to take the medication outweighed the risks,” the report said.
After the man’s death, his wife filed a complaint with the HDC.
“Above all, we want to prevent another avoidable death as a result of lack of expertise regarding the adverse effects of nitrofurantoin,” she said in her complaint.
Carolyn Cooper, deputy health and disability commissioner, found that health workers treating the man had “missed an opportunity” to properly inform him about the side effects of the drug.
“I am extremely critical that none of the health care providers who treated this man ensured he understood the risks, but I can’t think of any other individual or service that bore greater responsibility,” Mr Cooper said.
“All healthcare professionals who had a role in prescribing and administering nitrofurantoin to this man could have checked in good time whether he was aware of the long-term risks and it is concerning that they did not do so.”
One doctor said he was “heartbroken” to hear of the man’s death and apologised to the family.
“Any role I played in this process leaves me deeply disappointed. I feel responsible for this and am extremely disappointed that my involvement with him was not the small moment necessary to change trajectory from his untimely death.”
Cooper also said some doctors who prescribe and dispense nitrofurantoin, including the doctor who treated the man, were unaware of the risks of lung damage.
“This case shines a light on a very important issue and prompts necessary improvements and education to reduce the likelihood of similar incidents occurring in the future,” she said.
Following the man’s death, all medical professionals made “significant” changes and improvements to their nitrofurantoin prescribing procedures.
The pharmacy has urged the Drug Defence Association to disseminate proper information about the drug to all pharmacists in the area.
The Spine Unit has also produced an information document which is shared through the New Zealand Royal College of General Practitioners.
The medical center audited and monitored all patients prescribed nitrofurantoin and warned them about side effects.
