QuestionSBA
QuestionChoice
Due to this patient's renal impairment, intravenous co-amoxiclav should be given every 12 hours, not every 8 hours.
10028561
e
Co-amoxiclav 1.2g IV every 8 hours
QuestionChoice
There is only sensitivity to co-amoxiclav and so this is the correct choice of antibiotic. When it comes to dosing, the BNF advises that if CrCl 10–30 mL/min/1.73m<sup>2</sup>, the options are one 250/125 strength tablet every 12 hours or one 500/125 strength tablet every 12 hours.
10028557
a
Co-amoxiclav 250/125 PO every 12 hours
QuestionChoice
While this would likely be effective, piperacillin-tazobactam is reserved for patients with complicated UTI and in this situation, and there is no evidence to support the susceptibility of the microorganism to piperacillin-tazobactam.
10028559
c
Piperacillin-tazobactam 4.5g IV every 6 hours
QuestionChoice
This is incorrect because due to the patient's renal function, they need to have reduced frequency of co-amoxiclav. It should be 12-hourly instead of 8-hourly.
10028558
b
Co-amoxiclav 250/125 PO every 8 hours
QuestionChoice
Nitrofurantoin should not be prescribed with a eGFR <30 mL/min/1.73m<sup>2</sup>. The causative agent is also resistant to nitrofurantoin.
10028560
d
Nitrofurantoin 50mg PO every 6 hours
Concept
Chapter
2693
6088
UTI Treatment
Topic
330
Elderly Care
18114
Case Presentation:




An 83-year-old woman is on the Senior Health ward for treatment of delirium secondary to a urinary tract infection.


 **On Examination**
BP 121/82 mmHg, HR 80/min and regular, RR 10/min, Temperature 37.3 C. O2 sats 99% RA.


 **Investigations**
Urine dipstick: +++ leucocytes and nitrates


Urine MCS


R Nitrofurantoin


R Trimethoprim


S Co-Amoxiclav


||||
|---------------------------|:-------:|--------------------|
|Sodium|135 mmol/L|135 - 145|
|Potassium|4.6 mmol/L|3.5 - 5.3|
|Urea|10.5 mmol/L|2.5 - 7.8|
|creatinine clearance |25 mL/minute|100-150 ml/min|
|eGFR|28 mL/min/1.73m<sup>2</sup>|> 60|


Question:
Select the most appropriate decision option with regard to the management of her infection based on these data.
a