Explanation: Based on this patients CrCl nitrofurantoin is not expected to achieve adequate urinary concentrations so TMP/SMX is selected. Holding antibiotics isn’t appropriate because our patient has burning with urination. Always evaluating for asymptomatic bacteriuria is a great antimicrobial stewardship practice! However this patient has cystitis and treatment is warranted. The practice that ESBL = carbapenem is fairly common. Meropenem should be active for this patient’s infection but a carbapenem-sparing regimen helps reduce selective pressure for drug resistance.