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Antibiotic prescribing in CKD — ESENeph MCQ

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ModerateTherapeutics and Safe PrescribingAntibiotic prescribing in CKDESENeph

A 78-year-old woman with CKD G4 is prescribed nitrofurantoin for febrile UTI with flank pain. eGFR is 24 mL/min/1.73 m², temperature is 38.7°C and CRP is 118 mg/L. She has right renal angle tenderness. What is the most appropriate management?

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Correct answer: E — Use an alternative agent suitable for pyelonephritis and renal impairment

Nitrofurantoin is unsuitable for suspected pyelonephritis and has renal function restrictions; a systemic antibiotic appropriate to renal impairment and local microbiology is needed. Continuing nitrofurantoin risks under-treating upper tract infection. Delaying antibiotics in febrile upper UTI is unsafe. The pearl is that renal dosing and tissue penetration both matter when prescribing antimicrobials in CKD.

Reference: BNF; NICE Pyelonephritis Antimicrobial Prescribing Guideline