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Fick et al¹ provide some useful recommendations to avoid medications that produce unwarranted toxic effects or drug-related problems in older adults. It is surprising to find that nitrofurantoin was given a high-severity rating because of purported "potential for renal impairment." This assessment was based on group consensus using a modified Delphi method. Group opinions can be misinformed. There is no evidence-based support for this notion. Nitrofurantoin has many potential adverse effects, but I am unaware of reports that it causes renal failure.^2-3 Perhaps the intent of the expert panelists was to indicate that nitrofurantoin is contraindicated in patients with renal failure (creatinine clearance <60 mL/min) because of inadequate or subtherapeutic concentrations in the urine. The amount of nitrofurantoin excreted into the urine is directly related to renal function.⁴ Nitrofurantoin may be ineffective for treatment of urinary tract infections in elderly patients with reduced renal function, but it is not contraindicated . . . [Full Text of this Article]

Calvin M. Kunin, MD

Correspondence: Dr Kunin, Department of Internal Medicine, Ohio State University, 2447 Coventry Rd, Columbus, OH 43221 (ckunin@columbus.rr.com).

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