Review on nitrofuran derivative; nitrofurantoin induced neutropenia and agranulocytosis; it’s treatment goals

Abstract

Neutropenia is a clinical condition characterized by a reduced number of neutrophils, a type of white blood cell essential for defending the body against infections. It can occur due to chemotherapy, certain medications, autoimmune diseases, or bone marrow disorders. Nitrofurantoin, a nitrofuran derivative widely used for the treatment and prevention of uncomplicated urinary tract infections, has been rarely associated with severe hematological reactions such as neutropenia and agranulocytosis. These reactions result in increased susceptibility to infections and may become life-threatening if not promptly managed. Treatment of neutropenia primarily depends on its cause and severity. Pharmacological management includes colony-stimulating factors such as granulocyte colony-stimulating factor (G-CSF) drugs-filgrastim and pegfilgrastim-which stimulate bone marrow to produce neutrophils. In autoimmune cases, corticosteroids like prednisone are used to suppress immune-mediated destruction of neutrophils, while immunosuppressants such as cyclosporine or methotrexate are prescribed for chronic or severe cases. Febrile neutropenia requires immediate broad-spectrum antibiotics, with antifungal or antiviral agents added as necessary. Non-pharmacological measures involve discontinuing the causative drug, maintaining strict hygiene, ensuring a balanced diet, and regular blood count monitoring to assess recovery. Early detection, effective management, and awareness of drug-induced neutropenia can significantly reduce complications and improve patient outcomes. Advances in therapeutic strategies and infection control have enhanced the survival and quality of life of patients affected by this rare adverse effect