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Lower UTI treatment and renal function — GPhC CRA MCQ

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HardInfectionsLower UTI treatment and renal functionGPhC CRA

A 76-year-old woman has dysuria and frequency without fever or flank pain. Her urine culture is pending. The GP prescribes nitrofurantoin 100mg modified-release twice daily for 3 days, but her latest eGFR from last week is 28mL/min/1.73m2. What is the most appropriate alternative?

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Correct answer: D — Contact the prescriber for an alternative antibiotic

Nitrofurantoin is generally unsuitable when eGFR is significantly reduced because urinary concentrations may be inadequate and adverse effects may increase. With eGFR 28mL/min/1.73m2, the prescriber should choose an alternative based on guidance and culture risk. Community pharmacy should not independently substitute a prescription antibiotic. Cranberry is not appropriate treatment for symptomatic infection in this case.

Reference: BNF Nitrofurantoin; NICE CKS Urinary tract infection