Frederick William LE GRICE · Prevention of Future Deaths report

On 29th September 2022 I commenced an investigation into the death of Frederick William LE GRICE, aged 80. The investigation concluded at the end of the inquest on 29th September 2023. The conclusion of the inquest was natural causes, and that the medical causes of death were 1a) Pneumonia 1b) Interstitial Lung Disease 1c) Nitrofurantoin Toxicity II Left Ventricular Systolic Dysfunction

Frederick Le Grice suffered with prostate problems, which as is the case, and did in this case, lead to urinary tract infections. There are two particular antibiotics used to treat such infections, Nitrofurantoin and Trimethoprim, along with urology support in hospital. The deceased had still continued to get UTIs when on trimethoprim, so his general practitioner prescribed nitrofurantoin. That drug carries with it a known, but rare, risk of lung damage. After using Nitrofurantoin for a number of years, the deceased began to suffer with coughing and breathlessness. He was referred for specialist respiratory advice and some time later, the respiratory consultant advised that he had interstitial lung disease, and the likely cause of the problems was the Nitrofurantoin, and that this should be discontinued, which it was. The deceased died two years later from pneumonia, with the interstitial lung disease and the nitrofurantoin toxicity contributing.

(1) There is a known albeit rare side effect of Nitrofurantoin, of it causing lung damage. Nevertheless, neither the deceased himself, nor the clinicians involved in the deceased’s urinary care, who due to its specialism also have a prescribing function, were aware of the risk of lung damage from Nitrofurantoin.
(2) It is not very clear in the guidance to general practitioners or patients generally, that the patient and the treating clinicians should be particularly alert to any signs of coughing or breathlessness, and that if they are present, it may well suggest that Nitrofurantoin is causing damage to the patient’s lungs. Such damage is likely to be irreversible.
(3) I am concerned as to the effectiveness of the guidance and information available:
(i) to general practitioners and prescribers treating those using urinary catheters and/or suffering from urinary tract infections;
(ii) clinical staff in urology care;
(iii) patients themselves
Of the danger that Nitrofurantoin might cause lung damage, and (a) the need for all to be particularly vigilant as to symptoms and signs such as coughing or difficulty in breathing, and the desirability of their breathing and respiratory abilities being regularly monitored when a patient is using Nitrofurantoin (b) produce leaflets/information resources to that effect.