Getting Infection Right First Time

Please complete the prescription for nitrofurantoin modified release (MR) orally (PO) 100mg twice a day (BD) for Florence:

Have you considered:

Drug name (nitrofurantoin MR)
Dose (100mg)
Frequency BD (e.g. 8am and 8pm)
What infection are you treating/indication for antimicrobials
Review/stop date (3 days if female and uncomplicated UTI)
Prescribe on the initial section of the drug chart and circle probable (infection most likely) or possible (infection is not the most likely diagnosis)

ANTIMICROBIAL - Initial Prescription
Nitrofurantoin MR

Date →

Will stop here unless you prescribe again

24-72 hour Senior RV

Stop ☐
Continue
IV - oral ☐
No Change ☐
Change Drug ☐
Refer for OPAT ☐

Circle or insert time required

Day 1

Day 2

Day 3 review

Dose
100mg

Route
PO

Start Date
Day 1

Category of initial prescription (circle)

PROB'PROBABLE
☑

POSS'POSSIBLE
☐

Time prescribed
08:00

⑧

What infection are you treating?
Lower UTI

Pharm screen

Signature
A. Doctor

Print name and bleep
A DOCTOR #1234

Pharm supply

⑳

4. 24 Hours Later… Continued