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Recurrent upper urinary tract infection — MSRA MCQ

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ModerateUrologyRecurrent upper urinary tract infectionMSRA

A 46-year-old woman attends for review after her second culture-confirmed episode of acute pyelonephritis in 5 months. Both episodes involved fever, flank pain and dysuria, grew Escherichia coli, and resolved fully with culture-directed oral antibiotics. She is currently asymptomatic. She is not pregnant and has no diabetes, known urinary tract abnormality, renal impairment, visible haematuria between episodes, voiding symptoms or renal colic. What is the most appropriate next management step?

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

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Correct answer: E — Refer for specialist urological advice on further investigation and management

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

This woman has recurrent upper UTI: she has had 2 episodes of acute pyelonephritis within 5 months. NICE recommends referral or specialist advice for people with recurrent upper UTI, even when episodes have responded to treatment and there is no currently evident structural abnormality. The purpose is to consider investigation for an underlying cause and to guide prevention. A is reasonable supportive advice for recurrent UTI but is insufficient as the sole next step in recurrent pyelonephritis. B is not the appropriate independent primary-care action: decisions about antibiotic prophylaxis in recurrent upper UTI should follow specialist assessment/advice. C is also inappropriate without specialist advice; NICE specifically advises this when methenamine hippurate is being considered for recurrent upper UTI. E may form part of monitoring or assessment, but delayed testing without referral does not address the indication for specialist evaluation.

Reference: Urinary tract infection (recurrent): antimicrobial prescribing — Recommendations (2018, amended 2024) — https://www.nice.org.uk/guidance/ng112/chapter/recommendations Urinary tract infections in adults — Quality statement 5: Referring adults with recurrent urinary tract infection (Updated February 2023) — https://www.nice.org.uk/guidance/qs90/chapter/quality-statement-5-referring-adults-with-recurrent-urinary-tract-infection