QuestionSBA
QuestionChoice
Nitrofurantoin should not be prescribed with a eGFR <30 mL/min/1.73m<sup>2</sup>
34463
d
Nitrofurantoin 50mg QDS for 7 days
QuestionChoice
For trimethoprim, half the normal dose (200/2 = 100mg) should be used after 3 days if eGFR 15-30 mL/min/1.73m<sup>2</sup> 
34464
e
Trimethoprim 200mg PO BD for 7 days
QuestionChoice
Nitrofurantoin should not be prescribed with a eGFR <30 mL/min/1.73m<sup>2</sup>
34461
b
Nitrofurantoin 50mg QDS for 3 days
QuestionChoice
For trimethoprim, half the normal dose (200/2 = 100mg) should be used after 3 days if eGFR 15-30 mL/min/1.73m<sup>2</sup>. For UTI in males, antibiotic should be given over a total of 7 days
34460
a
Trimethoprim 200mg PO BD for 3 days, 100mg PO BD for the next 4 days
QuestionChoice
Piperacillin-tazobactam is reserved for patients with complicated UTI and in this situation, there is no evidence to support the susceptibility of the microorganism to piperacillin-tazobactam, hence, is less ideal than trimethoprim
34462
c
Piperacillin-tazobactam 4.5g TDS IV
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
2835
Management of UTI in renal disease
Topic
74
Elderly Care
6903
Case Presentation:




A 75-year-old man is transferred from the Acute Medical Unit to the Care of the Elderly Ward for treatment of his urinary tract infection.


 **On Examination**
BP 115/75 mmHg, HR 95/min and regular, RR 12/min, Temperature 38 C. O2 sats 94% RA.


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


Urine MCS


S Nitrofurantoin


S Trimethoprim


R Amoxicillin


R Co-Amoxiclav


||||
|---------------------------|:-------:|--------------------|
|Sodium|138 mmol/L|135 - 145|
|Potassium|4.8 mmol/L|3.5 - 5.3|
|Urea|8.5 mmol/L|2.5 - 7.8|
|Creatinine|210 µmol/L|60 - 120|
|eGFR|26 mL/min/1.73m<sup>2</sup>|> 60|


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