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Pyelonephritis — RACP Adult Medicine MCQ

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EasyInfectious DiseasesPyelonephritisRACP Adult Medicine

A 32-year-old woman presents with fever, dysuria, and right loin pain. Urine culture grows Escherichia coli. She is haemodynamically stable with no vomiting. According to eTG, what is the first-line oral antibiotic for acute pyelonephritis?

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Correct answer: D — Cefalexin 500 mg QID

According to the updated eTG Antibiotic guidelines (2025), cefalexin 500 mg QID for 10–14 days is first-line oral therapy for mild-to-moderate acute pyelonephritis in patients who can tolerate oral medication. Trimethoprim is used for uncomplicated lower UTI. Fluoroquinolones are reserved for multiresistant organisms or beta-lactam allergy due to antimicrobial stewardship concerns.

Reference: eTG – 2025 – Antibiotic Guidelines (Updated March 2025)