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UTI Allergy to First-Line — SCE Infectious Diseases MCQ

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EasyAntimicrobial StewardshipUTI Allergy to First-LineSCE Infectious Diseases

A 25-year-old woman presents with acute cystitis. She reports a severe allergy to Nitrofurantoin (anaphylaxis) and Trimethoprim (SJS). She is not pregnant. eGFR is >90. What is the most appropriate alternative oral antibiotic?

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Correct answer: B — Pivmecillinam 400 mg TDS for 3 days

When both Nitrofurantoin and Trimethoprim are contraindicated, Pivmecillinam (a beta-lactam with excellent urinary concentration and good Gram-negative coverage) is the recommended third-line oral option for uncomplicated cystitis per NICE NG109. Fosfomycin 3 g single dose is another alternative. Fluoroquinolones (Ciprofloxacin) should NOT be used for uncomplicated lower UTI due to the MHRA restriction on fluoroquinolone use for self-limiting infections and C. difficile risk. Cefalexin is another option.

Reference: NICE NG109 2018 – UTI; BNF 2024 – Pivmecillinam; MHRA 2019 – Fluoroquinolone restrictions