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UTI red flags — GPhC CRA MCQ

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ModerateInfectionsUTI red flagsGPhC CRA

A non-pregnant woman requests cystitis treatment but has dysuria, fever, rigors and unilateral loin pain. She is alert with no confusion. What is the most appropriate action?

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Correct answer: A — Arrange same-day upper-UTI assessment and provide explicit sepsis safety-netting

Arrange same-day upper-UTI assessment and provide explicit sepsis safety-netting: Systemic symptoms and loin pain indicate an upper urinary-tract infection, outside uncomplicated cystitis self-care and requiring prompt antimicrobial assessment. Manage as uncomplicated cystitis and review response after 48 hours: Fever, rigors and loin pain are upper-tract red flags regardless of dysuria. Use urinary alkalinising sachets and arrange routine review after the complete treatment course: Symptom relief would delay necessary treatment of a potentially serious infection. Use symptomatic loperamide and increase oral fluid intake during treatment: Loperamide has no role in urinary infection and does not address systemic illness. Arrange routine review after the weekend if oral fluids remain tolerated: Pyelonephritis requires same-day assessment and can progress to sepsis.

Reference: NICE NG109: lower UTI antimicrobial prescribing: https://www.nice.org.uk/guidance/ng109/chapter/Recommendations; NHS England Pharmacy First service specification and clinical pathways: https://www.england.nhs.uk/publication/community-pharmacy-advanced-service-specification-nhs-pharmacy-first-service/