Decision report 201201922

Summary

Mr C had been prescribed nitrofurantoin (an antibiotic drug used to treat bacterial infection) for a number of years for a recurring infection. He was then diagnosed with pulmonary fibrosis (a rare condition causing scarring of the lungs), which is a known side effect of nitrofurantoin and the drug was stopped. He complained that his medical practice failed to review his long-term prescriptions of nitrofurantoin appropriately.

The British National Formulary (BNF) provides national guidance for healthcare professionals about the prescribing of medicines. The BNF entry for nitrofurantoin says that lung and liver function should be monitored where someone had been prescribed this long-term. In addition, the General Medical Council (GMC) provide prescribing guidance, which says doctors should ensure that they are familiar with the BNF guidance for medicines they prescribe.

Our investigation found that during medication reviews the practice should have consulted the BNF to look up the long-term effects of the drug that they were prescribing. They should also have asked Mr C if he was having any problems with his breathing and recorded his response to this in the medical records. There was no evidence in Mr C's medical records that they had done so. Mr C also complained that the practice failed to consider the possible implications when he presented several times with breathing or chest problems. We obtained independent medical advice on this and found that the practice had acted reasonably in response to the symptoms Mr C presented with. However, in view of the fact that the practice had failed to consult the BNF about nitrofurantoin, they were not aware of the possible implications of taking the drug on a long-term basis. We, therefore, upheld both complaints.

Recommendations

We recommended that the practice:

• apologise Mr C for the failure to consult the BNF during medication reviews or at any other time to look up the long-term effects of nitrofurantoin.