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Asymptomatic bacteriuria before cataract surgery — SCE Geriatric Medicine MCQ

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HardInfectionAsymptomatic bacteriuria before cataract surgerySCE Geriatric Medicine

An 82-year-old has taken nitrofurantoin prophylaxis for eight months. She develops progressive dry cough, exertional hypoxaemia and bilateral interstitial infiltrates; heart failure and infection are not supported. What is the safest next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Stop nitrofurantoin immediately and investigate suspected pulmonary toxicity

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

B is correct: MHRA advice states that pulmonary reactions occur with short- or long-term nitrofurantoin and that new or worsening respiratory symptoms require prompt investigation; the medicine should be stopped immediately when pulmonary damage is suspected. Older people on long-term prophylaxis need particularly close respiratory monitoring and periodic liver surveillance. Dose reduction, formulation change or adding an inhaled steroid leaves the suspected causal exposure in place and risks progression to severe or irreversible lung injury.

Reference: MHRA: Nitrofurantoin pulmonary and hepatic adverse reactions: https://www.gov.uk/drug-safety-update/nitrofurantoin-reminder-of-the-risks-of-pulmonary-and-hepatic-adverse-drug-reactions