From the Research
For an 80-year-old patient with a history of nephrectomy, Macrobid (nitrofurantoin) should be used with caution or avoided altogether, as the patient's reduced kidney function may lead to subtherapeutic concentrations in the urine and potentially toxic levels in the blood 1. The recommended approach would be to use an alternative antibiotic instead of Macrobid. Nitrofurantoin is primarily eliminated by the kidneys and requires adequate renal function to achieve therapeutic concentrations in the urinary tract. Some key points to consider when selecting an alternative antibiotic include:
- Assessing the patient's current renal function with serum creatinine and estimated GFR to guide appropriate antibiotic selection and dosing
- Considering alternative antibiotics such as trimethoprim-sulfamethoxazole, cephalexin, or ciprofloxacin, with doses adjusted based on the patient's estimated glomerular filtration rate
- Monitoring for adverse effects, particularly in patients with reduced kidney function
- Being aware of the potential risks of hyponatremia and hyperkalemia associated with certain antibiotics, such as trimethoprim-sulfamethoxazole 2 The use of alternative antibiotics, such as trimethoprim-sulfamethoxazole, cephalexin, or ciprofloxacin, with careful monitoring and dose adjustment based on renal function, is a safer and more effective approach for treating urinary tract infections in patients with reduced kidney function 1.