Antibiogram-Guided Prescribing — SCE Infectious Diseases MCQ

Correct answer: D — Choose another guideline-listed first-line agent using renal function, pregnancy status and local susceptibility data

The best answer is “Choose another guideline-listed first-line agent using renal function, pregnancy status and local susceptibility data”. NICE requires local resistance and patient factors to guide empirical choice; a high local resistance proportion makes blind trimethoprim a poor option without individual susceptibility evidence. “Use trimethoprim because national guidance overrides local resistance” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use meropenem to guarantee activity” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Delay all treatment until a 14-day culture is complete” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Use two empirical antibiotics together to overcome resistance” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

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