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Nitrofurantoin renal function and pyelonephritis — GPhC CRA MCQ

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HardInfectionsNitrofurantoin renal function and pyelonephritisGPhC CRA

A 72-year-old woman is prescribed nitrofurantoin 100mg modified-release twice daily for lower UTI. Her record shows eGFR 32mL/min/1.73m2, temperature 38.3°C and right loin pain. What is the most appropriate alternative?

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Correct answer: A — Query the prescription and refer for assessment because symptoms suggest upper UTI and renal function is borderline.

Nitrofurantoin is unsuitable for suspected upper UTI because it does not achieve adequate tissue concentrations, and fever with loin pain suggests possible pyelonephritis. Renal function is also close to the lower threshold where use becomes restricted. The prescription should be queried and the patient assessed.

Reference: NICE CKS; BNF