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Rifampicin and contraception — GPhC CRA MCQ

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HardInfectionsRifampicin and contraceptionGPhC CRA

A patient with suspected cryptococcal meningitis needs urgent flucytosine-containing antifungal therapy. There is no known DPD deficiency, but pretreatment DPD testing is unavailable for 5 days. What is the most appropriate approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Start flucytosine now without awaiting routine DPD testing

Explanation lettering: C = shown as B · D = shown as C · E = shown as D · B = shown as E

A is not an evidence-based strategy for managing unknown DPD status. B delays recommended combination treatment for an unrelated test result. C unnecessarily withholds a key antifungal component despite the urgency. D cannot exclude a metabolic deficiency. E is correct: known complete DPD deficiency is a contraindication, but urgent treatment should proceed when status is unknown, with close haematological, hepatic and renal monitoring and DPD investigation if toxicity is suspected.

Reference: MHRA: Flucytosine—new contraindication in DPD deficiency. https://www.gov.uk/drug-safety-update/flucytosine-ancotil-new-contraindication-in-patients-with-dpd-deficiency