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Antimicrobial Stewardship — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipAntimicrobial StewardshipSCE Infectious Diseases

An antibiotic stewardship review identifies that a 70-year-old woman with a positive urine dipstick (leucocytes ++ and nitrites +) was started on Nitrofurantoin 100 mg BD. She is asymptomatic and was catheterised 5 days ago. Her eGFR is 25 mL/min/1.73 m². What stewardship interventions are needed?

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Correct answer: B — Stop antibiotics (asymptomatic bacteriuria in catheterised patient) and note that Nitrofurantoin is contraindicated at this eGFR

Two issues: first, asymptomatic bacteriuria in catheterised patients should NOT be treated (it does not improve outcomes and drives resistance). Second, Nitrofurantoin is contraindicated if eGFR <45 mL/min/1.73 m² as it accumulates systemically (risk of peripheral neuropathy and pulmonary reactions) and fails to achieve adequate urinary concentrations. The correct action is to stop the antibiotic.

Reference: NICE NG113 2018 – UTI: antimicrobial prescribing; NICE NG109 2018 – Catheter-associated UTI; BNF 2024 – Nitrofurantoin