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ESBL Cystitis — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipESBL CystitisSCE Infectious Diseases

A non-pregnant woman with uncomplicated lower UTI has an ESBL-producing E. coli susceptible to nitrofurantoin; eGFR is 65 mL/min and there are no upper-tract features. Which prescription is appropriate?

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Correct answer: C — Nitrofurantoin 100 mg modified release twice daily for 3 days, guided by susceptibility

The best answer is “Nitrofurantoin 100 mg modified release twice daily for 3 days, guided by susceptibility”. ESBL production does not preclude nitrofurantoin when the isolate is susceptible and infection is uncomplicated lower UTI with adequate renal function. NICE gives nitrofurantoin 100 mg modified release twice daily for 3 days in non-pregnant women. Carbapenem escalation and prescribing through reported fluoroquinolone or trimethoprim resistance are inappropriate.

Reference: NICE NG109 lower UTI: https://www.nice.org.uk/guidance/ng109/chapter/Recommendations