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C. difficile risk with antibiotics — GPhC CRA MCQ

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HardInfection ManagementC. difficile risk with antibioticsGPhC CRA

A culture-confirmed lower UTI is susceptible to nitrofurantoin and ciprofloxacin. The patient has eGFR 72 mL/min/1.73 m², no nitrofurantoin allergy, no previous treatment failure and no features of pyelonephritis. A ciprofloxacin prescription is presented. What is the best pharmacy response?

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Correct answer: C — Prescriber review of ciprofloxacin because nitrofurantoin remains suitable

MHRA restricts systemic fluoroquinolones to situations in which commonly recommended alternatives are inappropriate through resistance, contraindication, intolerance or failure. None applies here, so the prescription should be queried. Susceptibility alone does not justify exposing the patient to potentially disabling, long-lasting adverse reactions when a suitable first-line option exists. Lower UTI is not exempt. Dual therapy is unnecessary, and a pharmacist cannot simply change a prescribed POM outside an authorised prescribing or protocol framework.

Reference: MHRA: New restrictions for fluoroquinolone antibiotics. https://www.gov.uk/government/news/mhra-introduces-new-restrictions-for-fluoroquinolone-antibiotics