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Nitrofurazone (INN, trade name Furacin) is an antimicrobial organic compound belonging to the nitrofuran class.<ref name=":0">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is most commonly used as a topical antibiotic ointment.<ref name=":1" /> It is effective against gram-positive bacteria, gram-negative bacteria, and can be used in the treatment of trypanosomiasis.<ref name=":0" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Its use in medicine has become less frequent, as safer and more effective products have become available.<ref name=":2">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Nitrofurazone is listed under California Prop 65, and has demonstrated clear evidence to be mutagenic and carcinogenic during animal studies, and has been discontinued for human use in the USA.<ref name=":1">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name=":2" /><ref name=":3">Template:Cite news</ref><ref name=":4">Template:Cite journal</ref> The substance is pale yellow and crystalline. It was once widely used as an antibiotic for livestock.<ref>Template:Cite journal</ref><ref name=":5">Template:Cite news</ref>
Medical usesEdit
Human useEdit
Nitrofurazone was previously available as a prescription in the U.S., and was indicated as a topical solution, topical cream, or topical ointment for the treatment of bacterial skin infections, wounds, burns, and ulcers.<ref name=":1" /> It was also used as a prophylactic measure to prevent infection that could potentially result in skin graft rejection.<ref name=":0" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Nitrofurazone is still very popular as a topical solution for the treatment of tonsillitis in Russia.Template:Cn
Animal useEdit
Nitrofurazone is indicated for topical use in dogs, cats, and horses, for the treatment or prophylactic treatment of superficial bacterial infections, burns, and cutaneous ulcers.<ref name=":5" /> Preparations for treating infections, such as fin rot, in ornamental fish are also still commercially available.<ref name=":6">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite book</ref> The use of nitrofurazone, or related compounds, in animals raised for human consumption has been strictly banned.<ref name=":6" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
PharmacokineticsEdit
The metabolism of topically applied nitrofurazone is thought to be by 5-nitro reduction and cleavage of the -CH=N- linkage to generate a reactive species which can covalently bond to cellular macromolecules, none of the end products are thought to be antimicrobial.<ref name=":0" /><ref>Template:Cite book</ref>
Mechanism of actionEdit
The mechanism of action is not fully understood, but nitrofurazone's antimicrobial properties are suspected to be due to the interference of DNA synthesis in the microorganism by inhibiting certain enzymes that are involved with glycolysis.<ref name=":0" /><ref name=":2" /> Other enzymes this may affect include, pyruvate dehydrogenase, citrate synthetase, malate dehydrogenase, glutathione reductase, and pyruvate decarboxylase.<ref name=":0" />
Adverse effectsEdit
Adverse effects for topical use are generally mild and include, erythema, pruritus, dermatitis, rash, edema or inflammation.<ref name=":0" /><ref name=":1" />
ContraindicationsEdit
People with chronic kidney disease and large total body surface area (TBSA) burns should not use nitrofurazone, as topical preparations commonly contain polyethylene glycol, which is readily absorbed through the skin. Rapid absorption of the medication induces increased serum osmolalities and anion gap, leading to death.<ref name=":7">Template:Cite journal</ref> Symptoms are similar to ethylene glycol poisoning, in that increased serum calcium levels occur concurrently with decreased ionized calcium.<ref name=":7" />
Nitrofurans have been found in honey, meat and seafood. In people who have glucose-6-phosphate dehydrogenase deficiency (G-6-PD deficiency), ingestion of fish, poultry, or other foodstuff that has been treated with nitrofurans, will likely suffer from hemolysis of red blood cells as a result of eating the contaminated food.<ref name=":2" />
ToxicitiesEdit
Nitrofurazone is suspected to be a human carcinogen and is included in California's list of toxic chemicals as defined by Proposition 65.<ref name=":3" /><ref name=":4" /><ref>Template:Cite journal</ref> Studies demonstrate that nitrofurazone induces mammary tumors (fibroadenoma and adenocarcinoma) in rats and ovarian tumors in mice.<ref name=":4" /> In addition, animal studies demonstrated an increased incidence in convulsive seizures, ovarian atrophy, testicular degeneration, and degeneration of articular cartilage.<ref name=":4" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Proper personal protective equipment should be utilized when handling nitrofurazone.<ref name=":5" />
ReferencesEdit
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