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Uncomplicated UTI — MRCGP AKT MCQ

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EasyUrologyUncomplicated UTIMRCGP AKTUKMLAPARAPSA

A 20-year-old non-pregnant woman presents with a 2-week history of dysuria, urinary frequency and urgency. She has no fever, flank pain or vomiting. Her eGFR is 90 mL/minute/1.73 m². A midstream urine culture grows more than 10^5 cfu/mL of Escherichia coli that is susceptible to nitrofurantoin and ciprofloxacin but resistant to trimethoprim. She has no known drug allergies. According to NICE NG109, which is the most appropriate first-choice oral antibiotic regimen?

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Correct answer: A — Nitrofurantoin 100 mg modified-release twice daily for 3 days

Nitrofurantoin 100 mg modified-release twice daily for 3 days is the appropriate first choice. NICE recommends this regimen for uncomplicated lower UTI in non-pregnant women when eGFR is at least 45 mL/minute. Trimethoprim is also normally a first-choice option when resistance risk is low, but this isolate is resistant. Ciprofloxacin is unnecessarily broad spectrum and is not a NICE NG109 first-choice treatment for uncomplicated lower UTI. Amoxicillin and cefalexin are not listed as first-choice regimens for non-pregnant women in NG109. The absence of fever, flank pain and vomiting supports lower rather than upper UTI; nitrofurantoin should not be used to treat suspected pyelonephritis because it does not achieve adequate renal tissue concentrations.

Reference: NICE. Urinary tract infection (lower): antimicrobial prescribing, NG109, section 1.4 and Table 1. Published 2018; minor update May 2025. https://www.nice.org.uk/guidance/ng109/chapter/Recommendations