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Nitrofurantoin in renal impairment and upper UTI — GPhC CRA MCQ

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HardInfectionsNitrofurantoin in renal impairment and upper UTIGPhC CRA

A 67-year-old man is prescribed nitrofurantoin 100 mg modified-release twice daily for lower UTI. His eGFR is 28 mL/min/1.73 m2 and he has fever, rigors and loin pain. What is the most appropriate alternative?

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Correct answer: AUrgent medical assessment for possible upper UTI or sepsis

Nitrofurantoin is unsuitable for suspected upper UTI because it does not achieve adequate tissue levels, and reduced eGFR further limits use. Fever, rigors and loin pain suggest pyelonephritis or sepsis risk. The pharmacist should refer urgently rather than suggest an uncomplicated lower-UTI regimen.

Reference: BNF; NICE CKS