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Nitrofurantoin renal impairment — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentNitrofurantoin renal impairmentGPhC CRA

A 69-year-old woman is prescribed nitrofurantoin modified-release 100mg twice daily for 3 days for suspected lower UTI. Her latest eGFR is 24mL/min/1.73m2 and she has peripheral neuropathy from diabetes. She has no fever or flank pain. What is the most appropriate alternative?

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Correct answer: C — contact the prescriber for a non-nitrofurantoin option guided by local policy and culture risk

Nitrofurantoin is generally unsuitable in significant renal impairment because urinary concentrations may be inadequate and toxicity risk can increase. An eGFR of 24mL/min/1.73m2 should prompt prescriber contact for an alternative guided by local antimicrobial advice. Increasing the dose does not correct the renal limitation. Fluconazole would not treat bacterial cystitis.

Reference: BNF; NICE CKS: Urinary tract infection