Lower UTI in an Elderly Woman on Warfarin with Renal Impairment
Write a prescription for lower urinary tract infection and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.
medium7 scoring rulesrenal impairment
- Patient
- 79 years, female, 62 kg
- Diagnosis
- Lower urinary tract infection
- Renal function
- eGFR 40 mL/min/1.73m²
- Allergies
- None known
- Current medicines
- warfarin
The scenario
Mrs B-217 presents with a three-day history of burning dysuria, increased urinary frequency and urgency. She also reports suprapubic discomfort, but no fever, rigors, or loin pain. She has not noticed any visible blood in her urine. On examination, her temperature is 36.9 degrees Celsius, pulse 78 regular, blood pressure 134/82, and there is suprapubic tenderness on palpation. There is no renal angle tenderness. A urine dipstick is positive for nitrites and leukocytes, but negative for blood. Serum creatinine is 1.3 mg/dL, giving an eGFR of 40 mL/min/1.73 m2. Urea and electrolytes are within normal limits, as are liver function tests. The INR is 2.1, which is therapeutic for her warfarin. A mid-stream urine sample has been sent for culture and sensitivities. Please write an appropriate prescription for an oral antibiotic to treat this lower urinary tract infection.
Your task
Patient B-217 is a 79-year-old woman. Her weight is 62 kg. She has atrial fibrillation, hypertension and osteoarthritis. Her regular medications include warfarin 3 mg once daily, amlodipine 5 mg once daily, and paracetamol used as needed. She has no known drug allergies. She is a non-smoker and lives independently.
What gets marked
- Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
- Dose, route, frequency and duration against the range for this patient.
- Renal and hepatic dose adjustment where this patient's numbers demand it.
- Allergy cross-reactivity and interactions with the medicines already on the chart.
- The instructions and monitoring you write, not only the drug you pick.
7 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.
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A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.