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Re: puzzling caseFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Fri Feb 14 16:43:09 2003
At Fri, 14 Feb 2003, JOshea1770@aol.com wrote: > >Subject: Puzzling case - longish > >??Drug reaction to Macrobid - frequently pulmonary > >John O'Shea, MD > >State College > ACUTE, SUBACUTE, OR CHRONIC PULMONARY REACTIONS HAVE BEEN OBSERVED IN PATIENTS TREATED WITH NITROFURANTOIN. IF THESE REACTIONS OCCUR, MACRODANTIN SHOULD BE DISCONTINUED AND APPROPRIATE MEASURES TAKEN. REPORTS HAVE CITED PULMONARY REACTIONS AS A CONTRIBUTING CAUSE OF DEATH. CHRONIC PULMONARY REACTIONS (DIFFUSE INTERSTITIAL PNEUMONITIS OR PULMONARY FIBROSIS, OR BOTH) CAN DEVELOP INSIDIOUSLY. THESE REACTIONS OCCUR RARELY AND GENERALLY IN PATIENTS RECEIVING THERAPY FOR SIX MONTHS OR LONGER. CLOSE MONITORING OF THE PULMONARY CONDITION OF PATIENTS RECEIVING LONG-TERM THERAPY IS WARRANTED AND REQUIRES THAT THE BENEFITS OF THERAPY BE WEIGHED AGAINST POTENTIAL RISKS. (SEE RESPIRATORY REACTIONS.) Wow all this from one of my favorite drugs to treat uti's in pregnancy. Robert I am not sure this will turn out to be the cause, I would expect the pulmonary pathologist should have slides from previous reactions to compare histology. I would think she is already on high doses of I.V. Corticosteriods. ARDS secondary to sepsis is still a good bet. About the only thing I could think for a lowly Ob to do is to remember to take the stitch out, and ofcourse prayer can't hurt.
--
Take care, John
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