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Nitrofurantoin renal impairment — GPhC CRA MCQ

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HardInfectionsNitrofurantoin renal impairmentGPhC CRA

A 74-year-old woman receives nitrofurantoin 100mg modified-release twice daily for UTI. Her records show eGFR 32mL/min/1.73m2, fever 38.6C and new loin pain documented by the GP receptionist. What is the most appropriate action?

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Correct answer: D — Query urgently because pyelonephritis and renal impairment make nitrofurantoin unsuitable

Nitrofurantoin is unsuitable for suspected upper UTI because it does not achieve adequate renal tissue concentrations. Fever and loin pain raise concern for pyelonephritis and require clinical assessment. Reduced eGFR also affects nitrofurantoin suitability and efficacy. The prescription should be urgently queried rather than dispensed routinely.

Reference: BNF; NICE CKS Pyelonephritis