skip to main content

Lower UTI with renal impairment — GPhC CRA MCQ

Instant feedback + full explanation. One question, done properly.

HardInfectionsLower UTI with renal impairmentGPhC CRA

A 77-year-old woman presents with dysuria and urinary frequency for 24 hours. She has no fever, flank pain or vaginal discharge. Her SCR record shows eGFR 32mL/min/1.73m2 last month and she takes ramipril. What is the most appropriate alternative?

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

Reveal the answer and explanation

Correct answer: E — trimethoprim if local resistance risk and previous culture history support use

Nitrofurantoin is less suitable when eGFR is significantly reduced, particularly below 45mL/min/1.73m2, although short-course use may be considered cautiously in some patients with eGFR 30 to 44mL/min/1.73m2. With an eGFR of 32, trimethoprim may be a more appropriate option if susceptibility and resistance risk support it. The pharmacist should consider local antimicrobial guidance and safety issues such as hyperkalaemia risk with ACE inhibitors. Doxycycline and fluconazole do not treat uncomplicated bacterial cystitis.

Reference: BNF; NICE CKS: Urinary tract infection