QuestionSBA
QuestionChoice
Pivmecillinam cannot be given as the patient is penicillin-allergic
33988
d
Pivmecillinam hydrochloride 200mg PO TDS
QuestionChoice
Once a good first-line agent to treat uncomplicated lower urinary tract infections, there have been rising rates of antimicrobial resistance to trimethoprim recorded in many localities. Trust antibiotic guidelines should be consulted before prescribing this drug
33989
e
Trimethoprim 200mg PO BD
QuestionChoice
Amoxicillin cannot be given as the patient is penicillin-allergic
33986
b
Amoxicillin 500mg PO TDS
QuestionChoice
Nitrofurantoin concentrates well in urine but requires adequate remaining renal function and should be avoided in patients with eGFR <45
33987
c
Nitrofurantoin 100mg PO BD
QuestionChoice
Fosfomycin is an acceptable alternative in treating uncomplicated lower urinary tract infections if first-line treatments are ineffective or contraindicated
33985
a
Fosfomycin 3g PO OD
QuestionComment
BNF says fosfomycin is given for 1 dose only not once daily 
17575
QuestionComment
yeah OD.. for one dose
40462
User
subscriber
Respect
User
subscriber
Hereditary Hematoma
QuestionComment
why would you not go for trimethoprim?
39675
QuestionComment
The bug is resistant to Trimethoprim according to the micro sensitivities testing
39728
User
subscriber
Palatopterygoquadrate
User
subscriber
chili dip
QuestionComment
BNF says to avoid if <45 eGFR but follows up with that it can be used with caution...?
61092
QuestionComment
Use with caution as opposed to use fosfomycin which it is also sensitive to- with no issues. I see where you're coming but fosfomycin makes more sense

61905
User
subscriber
Miabetes Dellitus
User
subscriber
Lines of Zahn 
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2741
Nitrofurantoin in UTI
Topic
74
Elderly Care
6808
Case Presentation: A 71 year old woman is on the acute admissions unit being treated for acute confusion, urinary frequency and dysuria. **PH** breast cancer, focal segmental glomerulosclerosis. **DH** anastrozole 1mg PO OD, furosemide 120mg PO BD, atorvastatin 40mg PO ON, calcichew D3. Previous adverse drug reaction to penicillin – angioedema.


**O/E**

HR 84, RR 14, BP 147/76, O2 98% RA, Temperature 37.8°C, AMTS 4/10.

**Investigations**

U&Es: Na 143, K 4.7, Cl 103, Ur 6.0, Cr 210 (baseline 180), eGFR 32mL/min/1.73m^2

Urine MCS grows gram-negative rods (R=resistant, S=sensitive):

Trimethoprim – R

Nitrofurantoin – S

Pivmecillinam – S

Amoxicillin – S

Fosfomycin – S

Question: Select the most appropriate management at this stage.
a