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Nitrofurantoin renal impairment — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentNitrofurantoin renal impairmentGPhC CRA

A GP practice asks whether a patient with CKD stage 4 can continue nitrofurantoin 100mg MR twice daily for a lower UTI. Her eGFR today is 24mL/min/1.73m2 and she has fever and loin pain. What is the most appropriate alternative?

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Correct answer: A — Refer for urgent clinical assessment and alternative systemic antibiotic choice

Nitrofurantoin is unsuitable at this level of renal impairment because urinary concentrations may be inadequate and adverse effects increase. Fever and loin pain suggest possible upper UTI or pyelonephritis, for which nitrofurantoin is inappropriate. This is not a simple OTC cystitis scenario and requires prompt clinical assessment. Dose reduction would not solve the problem of inadequate urinary drug delivery.

Reference: BNF; NICE CKS UTI