PEBC MCQ Infectious Diseases & Immunization question: right flank pain

PEBC MCQInfectious Diseases & Immunization

JP, 41, has fever of 38.9 °C, right flank pain, nausea and dysuria. She can take oral fluids and will be treated at home. Which antibiotic is NOT appropriate for her?

a. Nitrofurantoin
b. Trimethoprim-sulfamethoxazole if the isolate is susceptible
c. Ciprofloxacin
d. Ceftriaxone followed by an oral agent

Show the answer and explanation

Answer: a. Nitrofurantoin

Nitrofurantoin and fosfomycin achieve therapeutic concentrations in the bladder but not in kidney tissue or blood, so they should not be used for pyelonephritis. Appropriate outpatient options include a fluoroquinolone, or an initial parenteral dose of ceftriaxone followed by an oral agent, or TMP-SMX when the organism is known to be susceptible, with culture guiding therapy. Source: Bugs & Drugs, Pyelonephritis (bugsanddrugs.org, checked 2026); nitrofurantoin product monograph, Indications limited to lower UTI (DPD, checked 2026).

Common mistake

Treating pyelonephritis with a cystitis-only antibiotic.

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Original practice material written to the public PEBC blueprint; not a past or real exam question. Not affiliated with or endorsed by The Pharmacy Examining Board of Canada (PEBC). Educational practice material for exam preparation only. Not medical advice and not a substitute for current product monographs, clinical guidelines or professional judgement. Questions have not yet been reviewed by a licensed pharmacist.